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

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 give your child an anti-grade malone flush using a coude catheter. Before giving your child a flush, always check with our team or your child's pediatrician. Nutrition for safety. Your child may need an enema because they're having constipation, or a hard time controlling their bowels. Enemas are usually given through a child's bottom or rectum, an anus, and the solution travels up the colon from the anus. When the 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 allows patients to give an enema to themselves more easily, which helps them gain independence and improve the 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 Kude catheter, a gravity bag with the roller clamp in the down position, closing the tubing, water soluble lubricant. 8 or 10 French coude catheters in the size that your provider recommends, saline or saltwater or plain water, whichever your provider recommends, a graduated cylinder or mixing bowl. And finally, irritants prescribed by your provider, such as glycerin, baby soap, or castile soap. 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. Place a pea-size amount of water-based lubricant on the end of your child's catheter to help it slide into your child's malone tract easily. Second, insert the catheter into the malone tract about 4 to 6 inches. Next, once the catheter is in place, connect the end of the filled gravity feeding bag to the top of the Kude catheter. Open the roller clamp on the gravity bag so that the solution can run into the Kude catheter over 10 to 15 minutes. By rolling this clamp down, you can make the solution slower. If the solution goes in too quickly, it can cause your child to have cramps. Once the solution is completely in your child, you can remove the catheter and the gravity bag. Have your child sit on the toilet for 30 to 45 minutes to allow the flesh to completely empty the colon. Clean all your supplies with soap and water and allow them to air dry. Your gravity bag and catheters can be used over and over again until they crack or leak. This may be years. Lastly, celebrate with your child. You've just performed a Malone antigrade flush. Here are some tips and tricks for your Malone flush. To help your child if they are having nausea or cramping, you can warm the saline or water by placing the filled gravity bag in a bowl of warm water. Remember not to shake the bag and 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. Do not give the flush 1 to 2 hours before or after they eat a meal. Please call or email your medical team if you experience any of the following problems, 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. If your child's Malone tract is new, you will need to work to keep the tract open for the 1st 6 months after surgery. Just like a newly pierced ear, the hole in the skin will attempt to close and heal. It's important that we keep this from happening. There are two ways you can do this. You can keep an Ace stopper in the malone tract. This is a small plastic plug that looks like a golf tee. Your child can keep this in the Malone tract all the time, taking it out only when they perform their flush. You will use water-soluble lubricant to insert the Ace stopper into the Malone site. And you keep it in place with a band-aid or small piece of tape. If you prefer not to use an Ace stopper, our team will have you pass the catheter in and out a second time each day without performing a flush, just to keep it open. This means if you perform your flush in the evening, each morning you will pass the catheter in and. Out without a flush. 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.