How to Give Your Child an Antegrade Malone Flush Using a Coude Catheter

Enemas given through a Malone travel from the top of the colon down to the rectum and out of the anus, opposite the direction of traditional rectal enemas

The goal of the Malone flush is to mechanically clean the colon of stool every 24 hours

If the Malone flush 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

Required supplies include 8 or 10 French coudé catheters in the size the provider recommends

Irritants prescribed by the provider may include glycerin, baby soap, or castile soap

Excessive shaking or stirring of the flush solution creates bubbles that can cause the child to feel gas and discomfort

Priming the tube means allowing liquid to run through the tubing until it comes out the bottom before connecting to the catheter

The catheter should be inserted into the Malone tract about 4 to 6 inches

The solution should run into the coudé catheter over 10 to 15 minutes

If the solution goes in too quickly, it can cause the child to have cramps

The child should sit on the toilet for 30 to 45 minutes to allow the flush to completely empty the colon

Gravity bags and catheters can be used over and over again until they crack or leak, which may be years

Warming the saline or water by placing the filled gravity bag in a bowl of warm water can help if the child is having nausea or cramping

Do not give the flush 1 to 2 hours before or after the child eats a meal

Red-flag symptoms requiring medical team contact include pain or redness at the Malone site, difficulty catheterizing the site, nausea or vomiting, no output or stool after the flush, or leaking from the Malone site

For the first 6 months after surgery, the Malone tract will attempt to close and heal like a newly pierced ear

An Ace stopper is a small plastic plug that looks like a golf tee and can be kept in the Malone tract all the time except during flushes

If not using an Ace stopper, the catheter should be passed in and out a second time each day without performing a flush to keep the tract open