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

Antegrade enemas travel from the top of the colon down to the rectum and out of the anus, opposite the direction of traditional rectal enemas

Antegrade flush allows patients to give enemas to themselves more easily, helping them gain independence

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

If successful, the child should not have any bowel movements between flushes and be accident-free

The flush must be given at the same time each day to achieve the best results

Shaking or stirring the solution too much creates bubbles that can cause gas and discomfort in the child

Priming the tube involves allowing liquid to run through the tubing until it comes out the bottom before administration

The extension tubing is locked into the MiniACE device by rotating it 3/4 to the right clockwise

5 to 10 mL of water should be inserted through the device before administration to ensure it is clear and water flows easily

The flush solution should run into the device over 10 to 15 minutes

If the solution goes in too quickly, it can cause cramping in the child

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

The gravity bag and catheter-tipped syringe can be reused until they crack or leak, which may be years

Warming the saline or water by placing the gravity bag in a bowl of warm water can help if the child complains of cramping

Slowing down the flush speed using the roller clamp can reduce nausea and cramping

The flush should be avoided 1 to 2 hours before or after meals to prevent nausea and cramping

Medical team should be contacted for pain or redness at the Malone site, unexpected device fallout, inability to pass solution, nausea or vomiting, no stool output after flush, or leaking from the site

Massaging the tubing can break up visible clogs blocking the gravity bag or extension tubing

Gently pushing and pulling a syringe plunger with 10 to 20 mL of warm water can free clogs in the tubing, and may require several cycles

If a clog cannot be removed, the MiniACE device may need to be replaced