HD 85 Suspension

Serious adverse reactions, including death, have been reported with the administration of barium sulfate formulations and are usually associated with the technique of administration, the underlying pathological condition and/or patient hypersensitivities.

Vomiting following oral administration of barium sulfate may lead to aspiration pneumonitis. Oral administration of barium sulfate suspension by an infant sucking a bottle and administration of large quantities by catheter are reported to be likely to result in aspiration into the tracheobronchial tree. Cardiopulmonary arrest leading to fatality has been reported in infants following aspiration. Aspiration of smaller amounts may cause inflammation.

Barium sulfate preparations used as radiopaque media contain a number of additives to provide diagnostic properties and patient palatability. Allergic responses following the use of barium sulfate suspensions have been reported. Skin irritation, redness, inflammation and hives have been reported for infants and small children following spillage of barium sulfate suspension on their skin. These responses are thought to be caused by the flavors and/or preservatives used in the product.

Barium sulfate suspension has been reported to cause obstruction of the small bowel (impaction) in pediatric patients with cystic fibrosis. It has also been reported to cause fluid overload from the absorption of water during studies in infants when Hirschsprung’s Disease is suspected.

Barium sulfate suspension intravasation can be a serious complication. Mortality has been reported as a result of vaginal or rectal intravasation and is believed to be due to massive pulmonary embolism occurring within minutes of the inciting event.

In patients with increased cranial pressure, barium sulfate suspension enemas present an additional risk of further increasing intracranial pressure.

Care must be taken during the insertion of an enema tip into the patient to prevent application of pressure to the vagus nerve which can lead to vasovagal reactions and syncopal episodes. Cardiac arrhythmia or other cardiovascular side effects can occur as a result of colon distention.

The volume and concentration used will vary depending upon the method of patient preparation, the desired level of contrast density, individual variation in patient anatomy and radiographic equipment. The following dilutions are suggested for HD 85:

Patient Preparation

Successful examination of the upper gastrointestinal tract requires that the stomach be empty and essentially free of fluid. This can usually be accomplished by instructing the patient to abstain from eating or drinking anything after the evening meal before the examination. The preparation for small bowel examinations, done separately or combined with an upper gastrointestinal series, is the same.

For examinations of the colon, the patient should be given a low solid diet for a minimum of 24 hours before the examination. Laxatives should also be used to clean the colon. In order to obtain thorough cleansing of the colon, a 2 liter water enema one hour before the examination may be necessary.

Double Contrast Colon Examination

The following procedure is suggested for double contrast examination of a well prepared adult colon. The procedure is intended as a guide only. The actual procedure will depend upon patient symptoms and conditions as well as physician preference and judgement. The examination should be performed by a trained physician or properly trained medical personnel.

An enema administration system with 1/2” ID tubing, such as Aircon, is used for ease of administration. At the physician’s discretion, fluoroscopy may be used during the introduction of the barium sulfate suspension to determine contraindications for continuing the examination.

Start with the patient either prone or in the left lateral position (physician preference). The enema tip is inserted and taped to the buttocks with one or two pieces of tape. Approximately 500 mL of HD 85 Suspension (or enough to reach the splenic flexure) is introduced into the colon.

After introducing HD 85 to the splenic flexure, the clamp on the large bore tubing is shut. The patient is now turned left anterior oblique and air is introduced.

The patient is turned to the prone position, air is introduced and the patient is rotated onto the right side. Additional air is introduced to move the column of HD 85 to the hepatic flexure. The patient is turned onto their back and additional air is introduced. If HD 85 has not reached the cecum, the head of the table may be raised to 45º. Finally, the patient is turned onto their left side and additional air is introduced. Additional turning of the patient with the introduction of air may be required to achieve complete distention of the colon.

With the patient prone, the enema bag is placed on the floor and the large bore tubing clamp opened in order to drain the barium sulfate suspension from the rectum. Spot films of the rectosigmoid may now be obtained. Additional air may be insufflated to provide adequate distention of the colon.

Removal of the exam tip at this time is optional, according to the preference of the examiner. Rotate the patient slowly 360° taking spot films and overhead radiographs.

Enteroclysis Examination

A barium sulfate concentration of 40 to 50% w/v is suggested. One part water added to one part HD 85 will provide a 42% w/v barium sulfate suspension.

Rectal Localization

HD 85 barium sulfate suspension may be used undiluted to radiographically locate the rectal area prior to radiation treatment.