Contrast media :barium sulfate

What (3) patients are at risk of extravasation involving barium leaking from GI tract into abdominal cavity?

-Elderly pt with long term use of steroid medication (Atrophic tissue increases chance of colon perforation) -pt with inflammation/degradation of intenstine due to diseases like diverticulitis or ulcerative colitis -patients who have had a recent biopsy of the colon (area might not be healed yet)

What's recommended for patients with a history of suspected perforation instead of barium? Give 3 examples

A water soluble iodine contrast Gastrografin, gastroview, hypaque

Although allergic reactions due to barium sulfate aren't common, they are possible and usually due to _______

Added preservatives in the barium sulfate or the latex in BE catheters

Barium sulfate is used for examination of the entire _______ canal

Alimentary

What makes up the barium compound used in contrast media: (give elements and chemical formula)

Barium + 0xygen + sulfate BaO2SO4

Why is suspected perforation a contraindication for barium studies? What can it cause?

Barium isn't absorbed by the body if it enters the peritoneal or pelvic cavity it can cause peritonitis requiring surgery

Why must we shake up the barium before a study?

Barium sulfate and water forms a colloidal suspension meaning the particles suspended in the water can settle

Why is obstruction/ constipation a contraindication for barium sulfate contrast? What do we instruct the patient to do to avoid this? What could happen if these instructions aren't followed?

Barium sulfate residue can dry up in the colon and cause constipation Have pt drink lots of water Fecal impaction or bowel obstruction

Hypervolemia is a contraindication during contrast studies using barium sulfate what is hypervolemia? when does it occur? What can hypervolemia cause?(4) What additive do manufacturers use in the barium sulfate to prevent hypervolemia?

Blood disorder where there is an increase in the volume of circulating blood when water from cleansing enema or BE goes from the colon into the circulatory system and increases blood volume Pulmonary edema, seizures, coma, death Table salt

within or by way of the intestine Or gastrointestinal tract Ex. Barium sulfate

Enteral

T or F: barium used as contrast media (mixture of barium sulfate and water) is a solution

False, colloidal suspension (never dissolves in water)

T or F: mentally handicapped and pts with altered mental status due to age/disease are not at a risk for aspiration

False, they are

When the barium sulfate in certain environments ,such as the acid of the stomach clumps up and comes out of suspension

Flocculation

Although a vaginal rupture is a rare contraindication for a contrast study using barium sulfate, how can it occur?

If the catheter is misplaced (females should be asked if they can feel the enema tip in the rectum)

Introduced into or occurring in the space under the arachnoid membrane of the spinal cord or brain

Intrathecal

Can barium sulfate be used intravascularly or intrathecally? Why or why not

No because it doesn't get absorbed by the body

What are some contraindications of barium sulfate? (8)

Perforation Obstruction/constipation Extravasation Vaginal rupture Hypervolemia Allergic reactions Sedated patients Barium in the appendix

What forms can barium sulfate come in?

Powder Liquid Paste Tablet

Flocculation occurs when barium clumps and comes out of suspension. Give two examples of stabilizing agents that prevent flocculation.

Sodium carbonate Sodium citrate

Why are sedated patients a contraindication for contrast studies using barium sulfate?

Their swallowing reflexes are diminished and therefore they're at a high risk of aspiration resulting in barium pneumonia

T or F: barium can occasionally collect within the appendix and is a contraindication although no directly related complications have resulted from this

True

T or F: the barium tip or retention canal can be a source of colon perforation and therefore the balloon should not be overinflated

True

A complication related to the administration of barium during a BE is perforation of the colon with extravasation into the abdominal cavity. What does extravasation mean in this case? What can this cause?

When barium leaks from the gastrointestinal tract into the abdominal cavity Peritonitis