Enteroclysis: The Small Bowel Enema (cont.)
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Administration of the Contrast
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- The barium suspension can be administered by
hand from a syringe or by gravity flow from an enema bag. However,
maximum success of the procedure is gained by having a constant flow
rate of the contrast medium. This can be achieved with the use of either
a hand pump (Jack Rabbit Pump, Black & Decker) or, better, with an
electric hemodialysis pump with digital readout of flow rates (MiniPump,
Renal Systems, Minneapolis, MN).
- A flow rate of 75 ml/min seems ideal for
most examinations, and small bowel transit will be accomplished in 5 -
10 minutes. A slower flow rate may lead to incomplete filling of bowel
loops, and a faster rate frequently causes excessive distention of the
bowel which leads to bowel paralysis and prolonged transit times. Reflux
into the stomach is associated with a considerably prolonged study. To
avoid small bowel over distension, ileus, and gastric reflux at the
beginning of the study, we start with an infusion rate of 50 ml/min and
gradually increase the rate towards 75 ml/min. If duodeno-gastric reflux
or decreased small bowel peristalsis is seen, the infusion rate is
adjusted downward until these signs disappear.
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