Appendicostomy tube

Cecostomy

Same thing as an appendicostomy except the connection is at the base of the cecum.

Flushing the Malone at Home for Patients with a Temporary Catheter (Malone Catheter)

• Gather your supplies: gravity bag, water based lubricant, timer, flush solution, graduated cylinder.
• Close the clamp on the gravity bag.
• Measure and pour the solutions as instructed by your provider into the graduated cylinder.
• Gently mix the solution and then pour it into the gravity feeding bag
• Remove air from the tubing by slowly opening the clamp and letting fluid run through to “prime” the tubing. Once you see drips at the end of the tubing, close the clamp.
• Hang the gravity bag above you on something such as a shower curtain rod or wall hook. Seat your child on the toilet.
• Connect tubing to the end of the Malone catheter (temporary catheter).
• Slowly open the clamp and let the solution run into the colon over 5-10 minutes. If your child has any cramping, slow down the rate of fluid by adjusting the clamp.
• When all of the solution has goin in, close the clamp and disconnect the tubing connected to the Malone catheter.
• Have your child sit on the toilet for 30-45 minutes to let the colon empty.
• Clean the gravity flush bag and catheter with soap and warm water. Then let the supplies air dry. The bag and Malone catheter can be used up to one month or replaced sooner if needed.

Flushing the Malone at Home for Patients Who have had the Malone Catheter Removed

• Gather your supplies: gravity bag, water based lubricant, timer, flush solution, graduated cylinder.
• Close the clamp on the gravity bag.
• Measure and pour the solutions as instructed by your provider into the graduated cylinder.
• Gently mix the solution and then pour it into the gravity feeding bag
• Remove air from the tubing by slowly opening the clamp and letting fluid run through to “prime” the tubing. Once you see drips at the end of the tubing, close the clamp.
• Hang the gravity bag above you on something such as a shower curtain rod or wall hook. Seat your child on the toilet.
• Remove the button stopper, connect the coude catheter to the gravity bag, put water soluble lubricant on the end of the coude catheter and insert it 3-4 inches into the Malone channel.
• Tape the coude catheter in place so it doesn’t dislodge. Click here if the coude catheter doesn’t insert (hyperlink to common problems)
• Slowly open the clamp and let the solution run into the colon over 5-10 minutes. If your child has any cramping, slow down the rate of fluid by adjusting the clamp.
• When all of the solution has gone in, remove the coude catheter from the Malone channel.
• Have your child sit on the toilet for 30-45 minutes to let the colon empty.
• Wash the area around the Malone channel with soap and water
• Clean and dry your child’s skin. Then put water soluble lubricant on the tip of the button stopper and insert it into the Malone channel.
• Clean the gravity flush bag and catheter with soap and warm water. Then let the supplies air dry. The bag and coude catheter can be reused up to one month or replaced sooner if needed.

How to Give a Patency Flush for Patient’s with the Malone Catheter

1. A patency flush is performed through the Malone catheter to prevent it from clogging. This should be done every day 8-10 hours after the Malone flush
2. Gather a catheter tip syringe and saline
3. Draw up 10 mL of saline into the catheter tip syringe and push it into the Malone catheter.

How to Place the ACE Stopper (Button Stopper)

1. Clean and dry your child’s skin with soap and water.
2. Put water based lubricant on the end of the ACE stopper so it can slide in easier.
3. Gently insert the stopper until the disc of the stopper is flat against your child’s belly.
4. Place a dressing or band-aid over the stopper to keep it in place.
5. Change the dressing every day.

Activity

Do not allow your child to shower until 48 hours after the surgery. Then shower normally. Do not allow your child to soak in a tub for one week. Do not allow your child to swim for two weeks. It is best to avoid vigorous activities and contact sports.

Signs of infection

If you notice severe redness, tenderness, warmth, a foul odor, thick yellow green drainage, or fever, call your care team immediately.

The Malone tube gets dislodged

Cover the site with a dry cloth and contact your provider. This may need to be replaced.

I can’t put the coude catheter in the appendicostomy

Get a washcloth and run it under warm water. Place the wash cloth on the opening for a few minutes to try and relax the opening. Gently try to place the coude catheter in again. If you still can’t put the coude catheter in, contact MDC for further assistance as there may be a stricture.

Skin or excess tissue growing around the appendicostomy

This is called granulation tissue, which is the body’s natural response to the appendicostomy. It is normal and harmless and can be treated with certain solutions prescribed by your physician. It is normal for this tissue to bleed a little when bumped or irritated.

If constipation is not improving

Adding 15 to 30 ml of mineral oil into the appendicostomy just before each irrigation may be helpful. Other things that may help can be of a pediatric Fleet enema into the catheter just before the irrigation, or glycerin.

If you notice break-through stooling in the middle of the day

Often the colon may contract throughout the day, leading to accidents. If this problem persists too often, contact your physician. They may consider adding a constipation medication to slow down the contractions of the colon.

Call your doctor and seek immediate medical care if you notice the following signs and symptoms:

• Signs of infection
  • Increase pain, swelling, warmth, redness around drain site
  • Pus draining from the insertion site
  • Fever
• Sudden change in color and smell of your drainage
• Tube is coming loose out of your insertion site