How to Give Your Child an Antegrade Malone Flush Using a MiniACE Balloon Device

Hello, I'm Megan Mesa, and I'm a nurse with the division of Colorectal and pelvic reconstruction at Children's National Hospital. I'm here today to review how to administer an anti-grademlog flush through a mini AC balloon device. Before giving your child a flush, always check with our team or your child's pediatrician for safety. Your child may need an enema because they are having constipation or a hard time controlling their bowels. Enemas are usually given through a child's bottom or rectum and anus, and the solution travels up the colon from the anus. When an enema is given through a malone, it travels the other direction. It moves from the top of the colon down to the rectum and out of the anus. This is called an anti-grade flush, or just a flush. This method of cleaning the colon is a great option for patients who do not like rectal enemas. It also allows patients to give an enema to themselves more easily, which can help them gain independence and improve their quality of their life. The goal of the Malone flush is to mechanically clean the colon of stool every 24 hours. If it is successful, the child should not have any bowel movements between flushes and be accident-free. It is important that the flush is given at the same time each day to achieve the best results. You will need the following supplies to complete an anti-grade flush using a mini ACE device. A gravity bag, extension tubing for the minisce, saline or saltwater or plain water, whichever your provider recommends, a graduated cylinder or mixing bowl, irritants prescribed by your provider such as glycerin, baby soap or castile soap, and a catheter tipped syringe. First, measure the solution with the amount of saline or water prescribed by your provider. Second, add the irritants prescribed by your provider in a measuring cup or graduated cylinder. Third, gently swirl the ingredients together. Do not shake or stir too much. If you do, that will create bubbles, and bubbles can cause your child to feel gas and discomfort. You just want the ingredients to mix lightly. 4th, make sure the roll clamp is pushed down on the gravity bag before you pour the solution into the gravity bag. 5th, once your solution is in the gravity bag, unroll the clamp slowly and allow the liquid to run through the tubing until it comes out the bottom. This is called priming the tube. Once the solution has traveled through the entire tubing, roll the clamp down tightly to close it. I will now show you how to give the prepared flush to a child using a mini Ace balloon device. First, attach the extension tubing to the mini Ace device by opening the flap on the top of the device. Next, line up the dark line on the extension tubing connector with the dark line on the mini Ace device. Fully press the extension tubing connector into the mini Ace device. Rotate the extension tubing 3/4 to the right clockwise. This will lock the extension tubing into place. Be sure. You are not trying to connect this to the balloon port, which has a blue band around it. Once the extension tubing is connected to the mini Ace, you can use a catheter tipped syringe to insert 5 to 10 mLs of water into the device to make sure it is clear and water goes through easily. Close the clamp on the extension tube and unscrew the syringe. Next, connect the end of the filled gravity bag to the extension tubing on the mini Ace. Open the roller clamp on the gravity bag and open the clamp on the extension tubing so that the solution can run into the device for over 10 to 15 minutes. You can slow down the speed of the flush by closing the roller clamp. If the solution goes in too quickly, it can cause your child to have cramps. You may need to further adjust the roller clamp to allow the solution to run faster or to slow it down. Once the solution is completely in your child, close the roller clamp and close the clamp on the extension tubing so no solution drips out and unhook the gravity bag from the extension set. You can now flush a small amount of water into the extension tubing to clean it out. Use the catheter tip syringe, and again, insert 5 to 10 mL of water into the extension tubing. Close the extension tubing and unscrew the syringe. Next, remove the extension set from the device. To do this, begin by removing the extension tubing by holding the mini Ace device in place and grabbing the extension tubing connector. Turn the connector 3/4 to the left, counterclockwise to unlock it. It should then lift up and out of the mini Ace device. You can then close the rubber flap back over the mini Ace opening. Have your child sit on the toilet for 30 to 45 minutes to allow the flesh to completely empty the colon. Lastly, clean all your supplies with soap and water and allow them to air dry. Your gravity bag and catheter tipped syringe can be used over and over again until they crack or leak. This may be years. And finally, time to celebrate with your child. You've just performed a Malone anti-grade flush. Here are some tips and tricks for all Malone flushes. If your child complains of cramping, you can warm the saline or water to help. To do this, place the solution while it is in the gravity bag in a bowl of warm water. Remember, do not shake the bag as this can cause bubbles. If your child is feeling nauseous or having a lot of cramping with their flush, you can also use the roller clamp to slow down the speed of the flush. Avoid giving the flush 1 to 2 hours before or after meals to prevent nausea and cramping. If you experience any of these problems, please call or email the medical team. Pain or redness at the Malone site, Mini ACE device. Falls out unexpectedly, unable to pass the solution through the mini Ace device, nausea or vomiting. No output or stool after the flush, leaking from the Malone site. If you are having a difficult time getting fluid to travel through the mini Ace, try these tricks. First, check to make sure that the gravity bag and or extension tubing is not kinked or clamped anywhere. If you can see something clogging or blocking the gravity bag or extension tubing, massage the tubing to break up the clog. You can also fill a catheter-tipped syringe with 10 to 20 mL of warm water. Connect the syringe to the extension tubing in the mini AC device, and gently push and pull the syringe plunger to free the clog. It may take several cycles of pushing and pulling the plunger to clear the clog. If the clog cannot be removed, contact your medical team. The mini ACE device may need to be replaced. If you want more information, please visit the Colorectal Program's website. We have multiple videos and printed resources to help you care for your child. And don't forget, always check with your child's pediatrician or our team when caring for your child's medical needs.