Saline enema Using a Foley catheter and saline (1188)

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.

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 a water-soluble lubricant. 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 200 ml or more of the saline.
• Saline solution.  To make the saline use this recipe:
  • 2 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. Never use plain tap water, without salt, for enemas.  The salt is important to keep your child's normal blood salt (electrolyte) level.

   

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

Getting ready to do the enema

You may need a helper to do the enema.  Older children may be able to learn to do this on their own.

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. Determine if you will use a Toomey Syringe or an enema bag.  An enema bag is best for larger volumes.
4. To test the balloon, pull up 10 ml of water with a luer lock syringe.  Put the 10 ml of water in the water balloon 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  a towel or pad on the floor or bed. Have your child lay on their left side and bend their knees midway to their chest.
8. Put water-soluble lubricant on the last 3 inches of the Foley catheter.

Giving the enema

1. Gently put the lubricated catheter tip into the anus about 3 or 5 inches
2. Connect the luer lock syringe to the water balloon port of the Foley. Push the 10ml of water in to gently blow up the balloon. Take the syringe out of the port.
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 and try again.

• Take all water out of the balloon with the syringe.
• Put the Foley in again.
• Connect the syringe to the water balloon port and push in 10 ml of water to blow up the balloon.
• Remove the syringe. Gently tug to be sure it stays in place.

4. Clamp the catheter with the green clamp.

5.  Connect the Toomey syringe or the enema bag. 

• If using the Toomey Syringe:
  • Insert the tip of the syringe into the enema port on the Foley catheter.
  • Hold the 60 ml syringe upright and pour 25 to 50 ml of the saline into it.
  • Unclamp the green clamp so the saline goes into your child's rectum.
  • Give the rest of the saline by pouring it into the open end of the syringe.

• If  using the enema bag:
  
  • Use the roller clamp on the bag's tubing to clamp the tube.
  • Fill the enema bag with the right amount of saline.
  • Insert the tip of the enema bag tube into the enema port on the Foley catheter.
  • Unclamp the roller clamp and the green clamp, so the saline goes into your child's rectum.

6.  If the saline does not flow freely into your child, poop may be plugging the hole in the catheter.  This prevents the saline from going in by gravity.  If this happens, the Toomey Syringe can be used to clear the hole.

• Attach the syringe to the enema port on the Foley catheter.  Use the plunger to gently push in about 10 ml of saline. 
• When the saline flows easily, the catheter is clear.
• Give the rest of the saline, following the instructions in step 5.

7.  When all the saline has gone in, clamp the catheter with the green clamp. Take the syringe or enema bag off the Foley. Your child will need to stay on their left side for about 10 minutes or as long as they are able.  There may be some small leakage of poop or saline.  Your child may look at 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. Attach the syringe to the water balloon port and 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. Try to make this a pleasant time and not treat it as a punishment.

11.  Note the amount of poop.  You do not need to measure.

12. Wipe and wash the anal area. Praise your child.

13. 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.

14. If using an enema bag, rinse the enema bag and put some paper towel in the bag. Then hang it to dry in the bathroom so that it drains and dries completely.