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How to Change Your Child’s MiniACE Balloon Device

Video Published 2023-06-16 Updated 2026-08-01

Topic Overview

A procedural instructional video demonstrating the step-by-step technique for changing a Mini-ACE (antegrade continence enema) balloon device in a pediatric patient with a Malone tract. The nurse instructor covers preparation of sterile water, device assembly with a blue stylet, balloon deflation and removal of the old device, insertion of the new device, and balloon inflation with 2ml sterile water. Troubleshooting guidance is provided for balloon deflation failure and reinsertion difficulty, with instructions to contact the colorectal nursing team when problems arise.

Key Takeaways

Boil tap water and cool to room temp to create sterile water for balloon inflation (2ml needed). (0:50)
Blue stylet stiffens tube for insertion; remove from irrigation port after placement, keep plunger down when disconnecting. (1:50)
Verify balloon security with gentle tug after inflating with 2ml sterile water. (1:50)
If balloon won't deflate, clean port with cotton swab; contact colorectal nursing if problem persists. (3:15)
Contact colorectal nursing team if unable to reinsert device after removal. (3:15)

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Justine Gagnon — host

Chapters

0:00Introduction and Safety Precautions — Nurse introduces herself and the Mini-ACE device purpose, emphasizing the need for medical team approval before changing the device.
0:50Supply Preparation and Sterile Water — Lists required supplies and demonstrates creating sterile water by boiling tap water and cooling to room temperature.
1:50New Device Preparation — Shows insertion of blue stylet into irrigation port, application of water-soluble lubricant, and preparation of 2ml sterile water in syringe.
2:30Old Device Removal — Demonstrates balloon deflation by withdrawing 2ml water with syringe and gentle removal of the old Mini-ACE from the Malone tract.
3:00New Device Insertion and Securing — Shows insertion of new device, stylet removal, balloon inflation with 2ml sterile water, and verification of secure placement by gentle tugging.
3:15Troubleshooting and Resources — Provides guidance for balloon deflation failure and reinsertion problems, directing families to contact the colorectal nursing team and access online resources.

Key claims

0:00The Mini-ACE device is used to perform a daily colon flush in pediatric patients — Justine Gagnon
0:00Families should only change the Mini-ACE device if instructed to do so by the child's medical team — Justine Gagnon
0:50Sterile water is created by boiling tap water and cooling it to room temperature — Justine Gagnon
1:50The blue stylet makes the Mini-ACE tube stiffer during insertion to facilitate placement — Justine Gagnon
1:50A pea-sized amount of water-soluble lubrication gel is applied to the end of the Mini-ACE device — Justine Gagnon
1:50The Mini-ACE balloon contains 2ml of sterile water when inflated — Justine Gagnon
2:30When the balloon is empty, it becomes hard to pull back on the syringe plunger — Justine Gagnon
3:00The blue stylet must be removed from the irrigation port after device insertion — Justine Gagnon
3:00The syringe plunger should be kept pushed down when disconnecting from the balloon port — Justine Gagnon
3:00Gentle tugging on the device verifies that the balloon is secure in the tract — Justine Gagnon
3:15If unable to deflate the balloon, cleaning the balloon port with a cotton swab may remove blocking substances — Justine Gagnon
3:15Families should contact the colorectal nursing team if unable to deflate the balloon after cleaning the port — Justine Gagnon
3:15Families should contact the colorectal nursing team if unable to reinsert the Mini-ACE device — Justine Gagnon

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Mini-ACE Balloon Device Exchange: Technical Sequence for Home Caregivers

The episode's teaching points arranged as a structured lesson, building from the basics up to the finer points. Written by Kai from the episode transcript and reviewed before publishing.

For specialists · Teaching arc · AI-written, human-reviewed

This demonstration walks through the complete sequence for exchanging a Mini-ACE balloon catheter in a pediatric Malone tract, focusing on the technical steps that prevent common failure modes.

Sterile water preparation sets the foundation. Tap water becomes sterile by bringing it to a full boil, then cooling to room temperature before use 0:50. This eliminates the need for purchased sterile water while maintaining safety for balloon inflation. The cooling step is non-negotiable — hot water damages the balloon material and burns tissue.

The blue stylet solves the buckling problem. The Mini-ACE tube is soft silicone, which collapses under axial force during insertion. The blue stylet inserted into the irrigation port stiffens the entire tube, preventing buckling and allowing controlled advancement into the tract 1:50. Without it, the tube folds on itself at the skin surface rather than tracking into the channel. Apply a pea-sized amount of water-soluble lubricant to the tube tip before insertion 1:50 — more lubricant migrates into the tract and interferes with balloon seal; less causes mucosal trauma.

Balloon deflation has a tactile endpoint. Connect an empty 5ml syringe to the balloon port and pull back on the plunger to withdraw the 2ml of sterile water from the balloon 1:50. The endpoint is not visual — you feel it. When the balloon is fully collapsed, resistance increases sharply and further retraction of the plunger becomes difficult 2:30. This hard stop tells you the balloon is empty and the device can be removed without tearing the tract. If you stop pulling before reaching this resistance, residual balloon volume will catch on the tract wall during removal.

Stylet removal and balloon inflation must happen in sequence. After inserting the new device, remove the blue stylet from the irrigation port first 3:00. The stylet occupies space inside the tube — leaving it in place during irrigation will cause back-pressure and incomplete flushing later. Then connect the pre-filled syringe to the balloon port and push 2ml of sterile water into the balloon. Keep the syringe plunger depressed while disconnecting from the port 3:00. Releasing pressure before disconnection allows air to enter the balloon, which creates an unstable anchor that shifts position with abdominal pressure changes. After disconnecting, tug gently on the external portion of the device 3:00. The balloon should resist — if it slides easily, the balloon is not inflated or the tract has dilated beyond the balloon's holding capacity.

Port obstruction is the most common technical failure. If the syringe plunger will not retract during balloon deflation, the balloon port is blocked — usually by dried flush solution, stool, or mucus 3:15. Clean the port opening with a dry cotton swab, rotating to dislodge any adherent material, then attempt deflation again. If this fails, the port valve has failed internally and the device must be cut at skin level and removed without deflation 3:15. This is not a home procedure. Similarly, if the new device will not advance into the tract despite proper stylet use and lubrication, the tract has narrowed or the angle has changed — stop and contact the colorectal nursing team rather than forcing placement 3:15.

The critical teaching point: only change the device when instructed. Families perform this exchange only after the tract has fully matured and the team has confirmed the family's technical competence 0:00. Premature device changes disrupt tract epithelialization and cause false passages. The Mini-ACE exists to deliver the daily antegrade continence enema 0:00 — the device change is maintenance, not therapy. Families who understand this distinction do not experiment with exchange timing or technique modifications.

Takeaways from this story

Balloon deflation endpoint is tactile: increased plunger resistance signals complete emptying, not volume withdrawn
Keep syringe plunger depressed during balloon port disconnection to prevent air entry and unstable anchoring
Blue stylet must be removed before irrigation to prevent back-pressure from obstructed lumen
Port obstruction responds to cotton swab cleaning; persistent failure requires team contact, not forced deflation

Keywords

Mini-ACE device change Malone antegrade continence enema colon flush Children's National Hospital Division of Colorectal and Pelvic Reconstruction

Transcript

Hi, I'm Justine Gagnon and I'm a nurse with the Division of Colorectal and Pelvic Reconstruction at Children's National Hospital. I'm here today to teach you about changing your Mini-ACE device. Before changing your Mini-ACE device, always check with our team or your child's pediatrician for safety. If you're watching this video, it's because your child has a Mini-ACE device to perform a daily colon flush. You should only change your Mini-ACE device if you have been instructed to do so by your child's medical team. You will need the following supplies, a 5ml slip tip syringe, water from your kitchen or bathroom sink, water-soluble lubrication gel, and the Mini-ACE device kit. First, bring about a cup of water to a boil to create sterile water. Be sure to allow the sterile water to cool to room temperature before using. Next, prepare your Mini-ACE device for insertion by removing it from the box and placing the blue stylet found in your kit into the irrigation port of the new Mini-ACE device. This stylet will make the tube stiffer during the insertion process, which will make it easier to place. Then, place a pea-sized amount of water-soluble lubrication gel on the end of the Mini-ACE device to make it slide into your child more easily. Use the syringe provided in the kit to pull up 2ml of sterile water. First, you will hold the Mini-ACE firmly in place with your hand. Use the other hand to connect an empty 5ml syringe to the balloon port. With the syringe connected, pull back on the plunger of the syringe to remove all water from the balloon. When the balloon is empty, it will be hard to pull back on the plunger anymore. There should be 2ml of sterile water now in your syringe. Remove the syringe from the port and discard the water. Now that you have removed the water from the balloon, you can gently pull back on the Mini-ACE and remove it from your child's Malone tract. Then, gently insert your new Mini-ACE device into the Malone site by holding the Mini-ACE firmly in place with your hand. Remove the blue stylet from the irrigation port of the Mini-ACE. Using your other hand, connect the pre-filled syringe to the balloon port. Once they are connected, push on the plunger of the syringe to fill up the balloon with 2 milliliters of sterile water. Disconnect the syringe from the balloon port. Be sure to keep the plunger of the syringe pushed down as you remove it. Then, very gently tug on the device to check that the balloon is secure in the tract. Celebrate with your child! You've just changed your child's device. If you try to deflate the Mini-ACE balloon and are unable to pull back any fluid, please clean the balloon port with a cotton swab to remove any substances that may be blocking the port. If you're still unable to deflate the balloon, please contact the colorectal nursing team to discuss next steps. If you are unable to reinsert the Mini-ACE device, please contact the colorectal nursing team to discuss next steps. 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.

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