Conduct Of The Examination

(Modification of "7 Pump Method" developed by Drs. Roscoe Miller and Dean Maglinte)

1. The patient remains in the left lateral position.
   1. Unclamp the tubing and allow barium to flow by gravity or by gently squeezing the enema bag.
   2. When you estimate that the rectum is filled with barium, check the position of the enema tip with fluoroscopy and inflate the retention balloon in the rectal ampulla with only one puff of air during fluoroscopic monitoring.
   3. You can avoid causing rectal discomfort and urgency throughout the examination by only half filling the balloon.
   4. Understand that the purpose of the balloon is to keep the enema tip from coming out - not to block egress of barium. 

   NOTE: Do not inflate the retention balloon in the presence of a large rectal tumor, acute inflammation, stricture, or recent biopsy because of the potential for rectal perforation. 

   NOTE: No further fluoroscopy is ordinarily necessary until Step #4, below. 
   
   

2. As the barium continues to flow, tilt head of x-ray table down about 15 degrees. When the bag is empty of barium, clamp the tubing, and return the table to a horizontal position.
   
   
3. Begin insufflating air at a rate of not more than one puff per second. Add 5 puffs of air in each of the following 9 patient positions: left lateral, LAO, prone, RAO, right lateral, RPO, supine, left lateral, and, finally, prone.
   
   

4. After the final turn and air insufflation, look to see that barium has entered the ascending colon. If barium is in the ascending colon, proceed to Step #5. If not, perform Modification #1, to be followed by Modification #2, if necessary (see Modifications, below). 
   
   
5. With the patient in the prone position, raise the head of the table 45&deg.  Place the barium bag between the patient's legs, unclamp the tubing, and allow barium to drain from the rectosigmoid.