Saline enema: using a Foley catheter - for children with poor strength in anal muscles

What is a saline enema?

Saline is made with salt and tap water. A saline enema is given to help your child empty their rectum of stool (poop). This will stop your child from having leakage during the day. A Foley catheter has a balloon that is used to stop the saline from leaking out of your child’s bottom until they are ready to deflate the balloon and empty their rectum. To make the saline use this recipe:

1½ level teaspoons of table salt in 1000 ml (The same as 1 quart or 4 cups) of tap water.

Caution: Do not change this recipe.

Your doctor wants you to give ____ ml of saline in the enema ____ times a day.

What supplies do I need?

• 60 ml large tip (Toomey) syringe.
• 10 ml luer lock syringe.
• Foley catheter and green clamp.
• ½ cup tap water to fill the balloon of the catheter.
• K-Y® Jelly or Lubafax™. Do not use Vaseline as it will damage the Foley.
• Potty chair, toilet or diaper for your child to pass the poop after the enema.
• A towel or plastic pad (Chux) for your child to lie on.
• An enema bag if you need to give 500 ml or more of the saline.
• Saline solution. Mix using the recipe above.

Getting ready to do the enema

1. Wash your hands.
2. Mix salt and warm water. Feel the water with your hand. It should not be too hot or cold. Measure the amount of enema that your doctor ordered.
3. Gather the supplies.
4. To test the balloon, Use a syringe to put 10ml of water in the side port of the Foley.
5. Remove the syringe to see if the water stays in. Note: If you do not remove syringe, the water will go back into the syringe. If the balloon leaks, you will need to get a new Foley.
6. Put the syringe back on and empty the balloon.
7. Have your child lie on their left side on a towel or pad on the floor or bed. Have your child bend their knees midway to their chest.
8. Put K-Y Jelly on the last 3 inches of the Foley catheter.

Giving the enema

1. Gently put the lubricated catheter tip into the anus about 2 or 3 inches
2. Connect the luer lock syringe to the side port of the Foley. Push the 10ml of water in to gently blow up the balloon. Take the syringe out of the port or the water will come back out. This could cause the Foley to fall out of the anus.
3. Gently tug at the Foley to make sure it doesn’t feel loose or slip out of the anus. If the Foley comes out of the anus with the balloon blown up, either it was not in far enough or you need more water in the balloon. Stay calm. Make sure to take all water out of the balloon with the syringe. Put the Foley in again. Use the syringe to add 10 ml of tap water in the side port again. Add another 10 ml of water into the side port and remove the syringe. Gently tug to be sure it stays in place.
4. Clamp the catheter. Then connect the 60 ml syringe without the plunger to the large port of the Foley.
5. Hold the 60 ml syringe upright and pour 25 to 50 ml of the saline into it.
6. Unclamp so the saline goes into your child’s bottom.
   • The stool may plug the hole in the catheter and keep the saline from going in by gravity.
     • If this happens, put the plunger on the 60 ml syringe to gently push about 10 ml of saline in to help clear the stool.
     • When the saline flows easily, the catheter is clear of stool.
     • Then remove the plunger. The rest should go in by gravity.
   • Give the rest of the saline by pouring it into the open end of the syringe.
   • Attach an enema bag if a large amount of solution will be used.
7. When all the saline has gone in, clamp the catheter. Take the syringe or enema bag off the Foley. Your child will need to stay on their left side for about 10 minutes. Give your child books or toys to distract them during this time.
8. When the time is up, your child can wear a diaper to the toilet. An older child may want to gently pull on the catheter until they get to the toilet. This will help keep poop from coming out while they are walking.
9. While your child sits on the toilet, take the water out of the balloon with the luer lock syringe. Pull back on the plunger until the balloon has gone down. The catheter tip will drop into the toilet along with poop behind it. Hang onto the clamp and catheter so it doesn’t fall into the toilet. Put it on a towel so it can be washed for reuse.
10. Your child should sit on the toilet for 20 minutes or until no more water or poop comes out. Give your child toys to play with during this time. Note the amount of poop.
11. Wipe and wash the anal area. Praise your child.
12. Wash supplies in warm soapy water. Flush soapy water through the Foley. Rinse all supplies well with clear water. Put them on a towel to air dry for the next use.
13. If using an enema bag to give large amount of saline, rinse the enema bag and place some paper towel in the bag. Then hang it to dry in the bathroom so that it drains and dries completely.