Providers to now use FL Small Bowel Water Soluble for abbreviated SBO evaluations.
SOUTH PUGET SOUND – Diagnostic Imaging has updated the protocol for small bowel obstruction (SBO) and small bowel follow-through imaging. This updated process is intended to improve safety, clarify ordering expectations and ensure patients receive the correct study based on the clinical question.
The new protocol, DI Protocol – Water Soluble SBFT (Previously Tracer / Gastro Challenge), replaces the abbreviated “Tracer” approach previously used for suspected SBO evaluations.
Why the protocol changed
Previously, providers often ordered XR Small Bowel Follow Through and entered “Tracer” or “SBO” in the exam reason or order comments. This indicated to technologists that an abbreviated bedside study was desired rather than a full diagnostic follow-through.
Those abbreviated tracer studies included barium, which can harden in the bowel and may worsen a small bowel obstruction. The updated protocol now uses Gastrografin, a hyperosmolar water-soluble contrast agent, alone.
About the new water-soluble SBFT protocol
The DI Protocol – Water Soluble SBFT is both a diagnostic study and therapeutic intervention for the evaluation and management of SBO. Some providers may know this exam by its informal names, including “contrast challenge” or “Gastrografin challenge.”
To support safe administration of contrast and reduce aspiration risk, this study requires the patient to have an NG tube in place.
How to order the correct study
When an abbreviated study is desired to evaluate suspected SBO, providers should order FL Small Bowel Water Soluble.
When other pathology is suspected, providers should order the standard FL Small Bowel Follow Through to indicate that a full fluoroscopic evaluation is needed.
Key takeaways for providers
- For suspected SBO requiring an abbreviated contrast challenge, order FL Small Bowel Water Soluble.
- For full evaluation of other small bowel pathology, order FL Small Bowel Follow Through.
- Do not rely on “Tracer” or “SBO” comments in the reason for exam to communicate the desired protocol.
- Ensure an NG tube is in place when ordering the water-soluble SBFT protocol.
