Antegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)AAntegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)Antegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)EnglishGastrointestinalPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Large Intestine/ColonLarge intestineProceduresCaregivers Adult (19+)NA2014-09-19T04:00:00ZKatharine Williams, RN (EC)Kimberley Colapinto, RN (EC), CETN7.7000000000000065.70000000000001916.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out how an antegrade continence enema can help your child and how to give an antegrade continence enema at home.</p><h2>What is an enema?</h2> <p>An enema is a liquid that is poured into the intestine to flush out stool. An antegrade continence enema (ACE) is an enema that is given through a passage between your child’s abdomen and intestine. The enema is a saline solution, which is a mix of water, salt and, sometimes, other ingredients.</p> <h2>What is an appendicostomy?</h2> <p>An appendicostomy is a surgery (operation) to create a passage between the abdomen and the intestine. The surgery usually involves stitching your child’s appendix (located at the end of the large intestine) to their abdomen. Although the surgery is usually called an appendicostomy, it can also be called a Malone procedure or MACE (Malone antegrade continence enema) procedure, after the surgeon who invented it.</p><h2>Key points</h2> <ul> <li>An antegrade continence enema (ACE) is a saline solution that is given through a tube into a passage between the abdomen and the intestine. </li> <li>Your child will need an appendicostomy to create the passage before receiving the ACE. After surgery, your child will have a stoma and be fitted with a tube to help the stoma keep its shape.</li> <li>Call your nurse if there is a problem with the tube or if your child's skin is irritated. Call the surgeon if your child has a fever, is vomiting or is in pain even after taking pain medicine or if the tube appears to be blocked. </li> <li>Your child's health-care team will teach you how to give an enema and tell you when you can start. Follow their instructions carefully.</li> <li>If an ACE is not effective, tell your nurse so that they can adjust the ACE solution or frequency.</li> </ul><h2>When to get medical help</h2> <p>Call your nurse immediately if there is: </p> <ul> <li>a crack in the Foley catheter </li> <li>unusual discharge, irritation, redness or skin cracking at the stoma. </li> </ul> <p>Call the surgeon's office if:</p> <ul> <li>your child has a <a href="/Article?contentid=30&language=English">fever</a> of 38°C (101°F) or higher</li> <li>the tube has accidentally dislodged (come loose from the stoma)</li> <li>you cannot flush out the tube or your child cannot pass stool through it </li> <li>there is too much drainage from around the tube</li> <li>your child is bleeding, red or swollen where the tube has been inserted</li> <li>your child is uncomfortable or in more pain even after taking pain medicine (including abdominal, back or leg pain)</li> <li>your child is vomiting (throwing up) </li> <li>your child's stomach is sore or distended (swollen or full)</li> <li>your child is lethargic, very tired or drowsy.</li> </ul> <h3>Important phone numbers</h3> <p>My child's nurse is: __________________________________</p> <p>Phone number: __________________________________</p> <p>My child's doctor is: __________________________________</p> <p>Phone number: _________________________________</p><h2>Why your child needs an appendicostomy and antegrade continence enema<br></h2> <p>Your doctor may suggest an appendicostomy if your child is soiling their clothes because of a medical condition such as <a href="/Article?contentid=959&language=English">anorectal malformation</a> or <a href="/Article?contentid=848&language=English">spina bifida</a> or is experiencing trauma.</p> <p>Having regular ACEs will help your child stay "socially clean" so that they can wear underwear 24 hours a day. It will also ease the distress you or your child may feel about your child soiling their clothes.</p><h2>What happens after an appendicostomy</h2> <p>After the appendicostomy, your child will have a stoma (opening) at or near their belly button. The stoma allows the tube to be inserted into your child's intestine for your child's daily ACE.</p> <p>To help the stoma heal and keep its shape, your child will have a tube attached to their abdomen with sutures (small stitches) and medical tape. This tube is called a Foley catheter and will stay in place for two to three weeks, until your child's first appointment with the surgeon after surgery.</p> <h2>When your child can go home after an appendicostomy</h2> <p>Children are usually ready to go home three to five days after surgery. Before discharging your child, your child's health-care team will need to confirm that:</p> <ul> <li>your child's heart rate, breathing, <a href="/Article?contentid=898&language=English">blood pressure</a> and temperature are normal</li> <li>your child can eat without <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up)</li> <li>your child is comfortable taking oral pain medicine (medicine taken by mouth)</li> <li>you (and your child if they are old enough) have completed training in performing an ACE</li> </ul> <h2>Taking care of your child at home after an appendicostomy</h2> <h3>Care of the incision</h3> <ul> <li>Clean the area around the stoma and Foley catheter with soap and water every day and pat dry.</li> <li>Keep the Foley catheter securely in place with tegaderm (a type of dressing) and tape.</li> <li>Only remove the catheter according to the surgeon's instructions.</li> <li>Watch out for any signs of infection at the stoma (see below).</li> </ul> <h3>Activities</h3> <p>Your child should only take part in quiet supervised play for the first 24 to 48 hours. Do not allow your child to lift anything heavier than five pounds or take part in strenuous activity for one week after surgery.</p> <h3>Diet</h3> <p>Your child may need to change their diet to ease any difficulties with stool or with gas or bloating. Your child should eat regularly and not go more than 48 hours without a bowel movement. Remember to give them plenty of fluids to prevent <a href="/Article?contentid=6&language=English">constipation</a> after surgery.</p> <h3>Bathing</h3> <p>Your child may shower the day after surgery and swim or take a bath one week after surgery.</p> <h3>Pain medicine</h3> <p>Your child will need to take pain medicine for the first few days after surgery. Always follow the instructions from the surgical team.</p><h2>At SickKids</h2> <p>Supplies for antegrade continence enemas are sold at the Specialty Food Shop on the main floor of the hospital.</p><h2>Source</h2><p>Cincinnati Children's Hospital Medical Center (2014). <em><a href="http://www.cincinnatichildrens.org/service/c/colorectal/treatments/bowel-management/">Bowel Management Program</a></em></p>
Irrigation colique antérograde avec appendicostomie (intervention de Malone — MACE)IIrrigation colique antérograde avec appendicostomie (intervention de Malone — MACE)Antegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)FrenchGastrointestinalPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Large Intestine/ColonLarge intestineProceduresCaregivers Adult (19+)NA2014-09-19T04:00:00ZKatharine Williams, RN (EC); Kimberley Colapinto, RN (EC), CETN8.0000000000000066.00000000000002140.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Découvrez de quelle façon une irrigation colique antérograde peut aider votre enfant et de quelle façon l’administrer à la maison.</p><h2>Qu’est-ce qu’un lavement?</h2><p>Un lavement est un liquide qui est versé dans l’intestin afin de le purger de ses selles. Une irrigation colique antérograde est un lavement qui est administré par un passage créé entre l’abdomen et l’intestin de votre enfant. Le lavement fait appel à une solution saline, soit un mélange d’eau, de sel et parfois d’autres ingrédients.</p><h2>Qu’est-ce qu’une appendicostomie?</h2><p>Une appendicostomie est une opération visant à créer un passage entre l’abdomen et l’intestin. Elle implique souvent la fixation de l’appendice (situé à l’extrémité terminale du côlon) à l’abdomen au moyen d’une suture. Bien qu’elle se nomme habituellement une appendicostomie, on la rencontre souvent sous le nom d’intervention de Malone ou MACE (irrigation colique antérograde de Malone), d’après le nom du chirurgien qui l’a inventée.</p><h2>À retenir</h2><ul><li>Une irrigation colique antérograde est constituée d’une solution saline qui est administrée au moyen d’une sonde par un passage reliant l’abdomen à l’intestin.</li><li>Votre enfant aura besoin d’une appendicostomie afin de créer ce passage avant qu’on puisse procéder à l’irrigation colique antérograde. Après l’intervention chirurgicale, il aura une stomie qui sera équipée d’une sonde afin qu’elle garde sa forme.</li><li>Communiquez avec votre infirmier si vous avez un problème avec la sonde ou si la peau de votre enfant est irritée. Communiquez avec le chirurgien si votre enfant a de la fièvre, s’il vomit ou s’il ressent de la douleur même après avoir pris un médicament anti-douleur ou si la sonde semble bloquée.</li><li>L’équipe de soins de santé de votre enfant vous enseignera la manière de faire un lavement et vous dira à quel moment vous pouvez commencer. Suivez ses instructions à la lettre.</li><li>Si une irrigation colique antérograde n’est pas efficace, mentionnez-le à votre infirmier afin qu’il ajuste la solution d’irrigation ou sa fréquence.</li></ul><h2>Quand demander une aide médicale?</h2><p>Communiquez immédiatement avec votre infirmier si vous observez :</p><ul><li>une fissure dans la sonde de Foley;</li><li>un écoulement, une irritation, une rougeur ou une gerçure inhabituels au site de la stomie.</li></ul><p>Communiquez avec le bureau du chirurgien si :</p><ul><li>votre enfant présente une <a href="/Article?contentid=30&language=French">fièvre</a> de 38 °C (101 °F) ou plus;</li><li>la sonde s’est délogée accidentellement (est sortie de la stomie);</li><li>vous ne pouvez pas nettoyer la sonde ou votre enfant n’arrive pas à évacuer ses selles au travers;</li><li>il y a une présence excessive d’écoulement autour de la sonde;</li><li>le site d’insertion de la sonde présente des saignements, de la rougeur ou de l’enflure;</li><li>votre enfant ressent un malaise ou de la douleur même après avoir pris un médicament anti-douleur (y compris des douleurs abdominales, au dos ou aux jambes);</li><li>votre enfant vomit;</li><li>l’abdomen de votre enfant est douloureux ou distendu (enflé ou plein);</li><li>votre enfant est léthargique, très fatigué ou somnolent.</li></ul> <h3>Numéros de téléphone importants</h3><p>Nom de l’infirmier de mon enfant :</p><p>________________________________________<br></p><p>Numéro de téléphone :</p><p>________________________________________</p><p>Nom du médecin de mon enfant :</p><p>________________________________________</p><p>Numéro de téléphone :</p><p>________________________________________</p><h2>Pour quelle raison votre enfant a-t-il besoin d’une appendicostomie et d’une irrigation colique antérograde?</h2><p>Votre médecin pourrait vous suggérer une appendicostomie si votre enfant souille ses vêtements en raison d’un problème médical comme une <a href="/Article?contentid=959&language=French">malformation ano-rectale</a>, un <a href="/Article?contentid=848&language=English">spina-bifida</a> ou un traumatisme.</p><p>Avoir une irrigation colique antérograde de façon régulière aidera votre enfant à rester « socialement propre » de sorte qu’il pourra porter des sous-vêtements toute la journée. Elle soulagera aussi l’angoisse que votre enfant et vous ressentez lorsqu’il souille ses vêtements.</p><h2>Que se passe-t-il après une appendicostomie?</h2><p>Après l’appendicostomie, votre enfant aura une stomie (un orifice) à la place de son nombril ou juste à côté. Elle permet le passage de la sonde jusque dans son intestin pour son irrigation colique antérograde quotidienne.</p><p>Afin que la stomie guérisse et qu’elle conserve sa forme, une sonde sera fixée à l’abdomen de votre enfant avec des sutures et du ruban adhésif. Cette sonde se nomme sonde de Foley et elle restera en place pour deux à trois semaines, jusqu’au rendez-vous de suivi de votre enfant avec son chirurgien.</p><h2>Quand votre enfant obtient-il son congé après une appendicostomie?</h2><p>Les enfants sont habituellement prêts à rentrer à la maison de trois à cinq jours après l’intervention chirurgicale. Avant d’accorder son congé à votre enfant, son équipe de soins de santé devra confirmer :</p><ul><li>que son rythme cardiaque, sa respiration, sa <a href="/Article?contentid=898&language=French">pression sanguine</a> et sa température corporelle sont normaux;</li><li>qu’il s’alimente sans <a href="/Article?contentid=746&language=French">vomir</a>;</li><li>qu’il est à l’aise de prendre des médicaments anti-douleur oraux (administrés par la bouche);</li><li>que vous, ou votre enfant s’il est suffisamment âgé, avez obtenu la formation permettant d’exécuter l’irrigation colique antérograde.</li></ul><h2>Prendre votre enfant en charge à la maison après une appendicostomie</h2><h3>Soins à apporter à l’incision</h3><ul><li>Chaque jour, nettoyez la zone entourant la stomie et la sonde de Foley à l’ eau savonneuse et tapotez-la afin de la sécher.</li><li>Maintenez la sonde de Foley en place à l’aide d’un pansement Tegaderm et de ruban adhésif.</li><li>Suivez les instructions du chirurgien si vous retirez la sonde.</li><li>Surveillez les symptômes d’infection près de la stomie (voir plus bas).</li></ul><h3>Activités</h3><p>Votre enfant devrait seulement prendre part à des jeux tranquilles et supervisés de 24 à 48 heures après l’opération. Ne le laissez pas soulever des objets dont le poids dépasse cinq livres (2,2 kg) ni prendre part à des activités ardues a première semaine suivant l’intervention chirurgicale.</p><h3>Régime alimentaire</h3><p>Votre enfant devra changer son régime alimentaire afin de faciliter le passage des selles, diminuer la production de gaz ou la sensation de ballonnement. Il devrait manger selon un horaire régulier et ne pas dépasser 48 heures sans aller à la selle. N’oubliez pas de lui offrir beaucoup de liquide afin de prévenir la <a href="/Article?contentid=6&language=French">constipation</a> après l’intervention chirurgicale.</p><h3>Prendre une douche ou un bain</h3><p>Votre enfant pourra prendre une douche le lendemain de l’intervention chirurgicale et s’immerger dans l’eau (à la baignade ou dans le bain) une semaine plus tard.</p><h3>Médicaments anti-douleur</h3><p>Votre enfant devra prendre des médicaments anti-douleur pendant les premiers jours suivant l’opération. Suivez toujours les instructions de l’équipe chirurgicale.</p><h2>À l’hôpital SickKids</h2><p>Les fournitures pour les irrigations coliques antérogrades sont vendues à l’épicerie spécialisée située au rez-de-chaussée de l’hôpital.<br></p><h2>Source<br></h2><p>Centre médical de l’Hôpital pour enfants de Cincinnati (2014). <em><a href="http://www.cincinnatichildrens.org/service/c/colorectal/treatments/bowel-management/">Bowel Management Program</a></em>.<br></p>

 

 

 

 

Antegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)983.000000000000Antegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)Antegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)AEnglishGastrointestinalPreschooler (2-4 years);School age child (5-8 years);Pre-teen (9-12 years);Teen (13-18 years)Large Intestine/ColonLarge intestineProceduresCaregivers Adult (19+)NA2014-09-19T04:00:00ZKatharine Williams, RN (EC)Kimberley Colapinto, RN (EC), CETN7.7000000000000065.70000000000001916.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Find out how an antegrade continence enema can help your child and how to give an antegrade continence enema at home.</p><h2>What is an enema?</h2> <p>An enema is a liquid that is poured into the intestine to flush out stool. An antegrade continence enema (ACE) is an enema that is given through a passage between your child’s abdomen and intestine. The enema is a saline solution, which is a mix of water, salt and, sometimes, other ingredients.</p> <h2>What is an appendicostomy?</h2> <p>An appendicostomy is a surgery (operation) to create a passage between the abdomen and the intestine. The surgery usually involves stitching your child’s appendix (located at the end of the large intestine) to their abdomen. Although the surgery is usually called an appendicostomy, it can also be called a Malone procedure or MACE (Malone antegrade continence enema) procedure, after the surgeon who invented it.</p><h2>Key points</h2> <ul> <li>An antegrade continence enema (ACE) is a saline solution that is given through a tube into a passage between the abdomen and the intestine. </li> <li>Your child will need an appendicostomy to create the passage before receiving the ACE. After surgery, your child will have a stoma and be fitted with a tube to help the stoma keep its shape.</li> <li>Call your nurse if there is a problem with the tube or if your child's skin is irritated. Call the surgeon if your child has a fever, is vomiting or is in pain even after taking pain medicine or if the tube appears to be blocked. </li> <li>Your child's health-care team will teach you how to give an enema and tell you when you can start. Follow their instructions carefully.</li> <li>If an ACE is not effective, tell your nurse so that they can adjust the ACE solution or frequency.</li> </ul><h2>When to get medical help</h2> <p>Call your nurse immediately if there is: </p> <ul> <li>a crack in the Foley catheter </li> <li>unusual discharge, irritation, redness or skin cracking at the stoma. </li> </ul> <p>Call the surgeon's office if:</p> <ul> <li>your child has a <a href="/Article?contentid=30&language=English">fever</a> of 38°C (101°F) or higher</li> <li>the tube has accidentally dislodged (come loose from the stoma)</li> <li>you cannot flush out the tube or your child cannot pass stool through it </li> <li>there is too much drainage from around the tube</li> <li>your child is bleeding, red or swollen where the tube has been inserted</li> <li>your child is uncomfortable or in more pain even after taking pain medicine (including abdominal, back or leg pain)</li> <li>your child is vomiting (throwing up) </li> <li>your child's stomach is sore or distended (swollen or full)</li> <li>your child is lethargic, very tired or drowsy.</li> </ul> <h3>Important phone numbers</h3> <p>My child's nurse is: __________________________________</p> <p>Phone number: __________________________________</p> <p>My child's doctor is: __________________________________</p> <p>Phone number: _________________________________</p><h2>Follow-up appointment after an appendicostomy</h2> <p>After two to three weeks, your child will return to the clinic for a follow-up appointment. The surgeon will remove the Foley catheter that was fitted during the appendicostomy. A nurse will then teach you how to insert and remove the catheter that you will use for your child's daily ACE.</p><h2>Why your child needs an appendicostomy and antegrade continence enema<br></h2> <p>Your doctor may suggest an appendicostomy if your child is soiling their clothes because of a medical condition such as <a href="/Article?contentid=959&language=English">anorectal malformation</a> or <a href="/Article?contentid=848&language=English">spina bifida</a> or is experiencing trauma.</p> <p>Having regular ACEs will help your child stay "socially clean" so that they can wear underwear 24 hours a day. It will also ease the distress you or your child may feel about your child soiling their clothes.</p><h2>What happens after an appendicostomy</h2> <p>After the appendicostomy, your child will have a stoma (opening) at or near their belly button. The stoma allows the tube to be inserted into your child's intestine for your child's daily ACE.</p> <p>To help the stoma heal and keep its shape, your child will have a tube attached to their abdomen with sutures (small stitches) and medical tape. This tube is called a Foley catheter and will stay in place for two to three weeks, until your child's first appointment with the surgeon after surgery.</p> <h2>When your child can go home after an appendicostomy</h2> <p>Children are usually ready to go home three to five days after surgery. Before discharging your child, your child's health-care team will need to confirm that:</p> <ul> <li>your child's heart rate, breathing, <a href="/Article?contentid=898&language=English">blood pressure</a> and temperature are normal</li> <li>your child can eat without <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up)</li> <li>your child is comfortable taking oral pain medicine (medicine taken by mouth)</li> <li>you (and your child if they are old enough) have completed training in performing an ACE</li> </ul> <h2>Taking care of your child at home after an appendicostomy</h2> <h3>Care of the incision</h3> <ul> <li>Clean the area around the stoma and Foley catheter with soap and water every day and pat dry.</li> <li>Keep the Foley catheter securely in place with tegaderm (a type of dressing) and tape.</li> <li>Only remove the catheter according to the surgeon's instructions.</li> <li>Watch out for any signs of infection at the stoma (see below).</li> </ul> <h3>Activities</h3> <p>Your child should only take part in quiet supervised play for the first 24 to 48 hours. Do not allow your child to lift anything heavier than five pounds or take part in strenuous activity for one week after surgery.</p> <h3>Diet</h3> <p>Your child may need to change their diet to ease any difficulties with stool or with gas or bloating. Your child should eat regularly and not go more than 48 hours without a bowel movement. Remember to give them plenty of fluids to prevent <a href="/Article?contentid=6&language=English">constipation</a> after surgery.</p> <h3>Bathing</h3> <p>Your child may shower the day after surgery and swim or take a bath one week after surgery.</p> <h3>Pain medicine</h3> <p>Your child will need to take pain medicine for the first few days after surgery. Always follow the instructions from the surgical team.</p><h2>When to start performing an antegrade continence enema</h2><p>Your child's surgeon will tell you when you can start performing antegrade continence enemas with the first Foley catheter in place. This is usually within a few days of the appendicostomy.</p><p>The nurses in the hospital will teach you how to give the antegrade continence enema. On the days that your child is not having an ACE, you should flush the Foley catheter with a mix of salt and water. Your child's surgeon will tell you how much to use.</p><h2>How to give an antegrade continence enema </h2> <p>Most children need to have the ACE performed every day, but the frequency is tailored to each child's needs.</p><h3>Gather your supplies</h3><p><br>Get your supplies together before you start preparing the enema. You will need:</p><ul><li>Zevex — 1200 Enteral Delivery Set (GR1200)<br></li><li>a Foley catheter (your doctor will tell you which size you need)</li><li>syringe, 5 mL, slip tip (BD #301603)</li><li>syringe, 60 mL, catheter tip (BD #309620)</li><li>water-based lubricant such as K-Y jelly or Muko.</li></ul><p>You can buy these supplies from your local pharmacy or, if living in Ontario, from Ontario Ostomy Supply.</p><p>Most insurance companies cover the cost of supplies. Please ask your nurse if you qualify for any government programs, grants or tax credits that help with the cost.</p><h3>Make up the saline solution</h3><p>Mix 500 mL (2 cups) tap water (water you would drink) with 3/4 teaspoon table salt. This is a standard recipe for saline solution. <strong>Do not change it.</strong> </p><p>The amount of saline solution used in the enema depends on each child and their weight. You will be told how much to use for your child.</p><h3>Prepare the enema</h3><ol><li>Gather your equipment:</li><ul><li>an enema bag and tubing (Zevex Enteral Delivery Set)</li><li>a Foley catheter with a 3 mL balloon</li><li>water-based lubricant</li><li>a 30 mL syringe (slip tip)</li><li>a 60 mL syringe (catheter tip — for cleaning catheter after the enema).</li></ul><li>Make up the saline solution.</li><li>Clamp the tube of the enema bag and pour the saline into it. Mix well.</li><li>Open the clamp and allow the fluid to flow out of the bag.</li><li>Squeeze the drip chamber on the tubing until it is half filled with fluid. Then fill the entire tubing. This is called "priming the tubing".</li></ol><h3>Give the enema to your child</h3><ol><li>Have your child sit on the toilet.</li><li>Lubricate the Foley catheter.</li><li>Gently introduce the catheter into the appendicostomy and slowly insert 5-7 cm. You may secure the Foley catheter to the skin with a piece of tape.</li><li> <em>Optional: If you have been told to inflate the balloon of the Foley catheter, attach the 5 mL syringe (filled with air) to the small port on the catheter. Fill the balloon with 3 mL of air. As soon as the balloon is inflated, take the syringe off the catheter to prevent the balloon from deflating.</em></li><li>Tilt the enema bag to allow for a steady flow of saline solution into your child. If the saline solution is flowing too quickly, use the roller clamp on the tubing or lower the bag.</li><li>After the enema is completed, simply remove the tape and remove the Foley catheter gently. <em>If you had inflated the balloon, deflate it first by connecting the 5 mL syringe to the same port and removing the air. This will allow the Foley catheter to slip out.</em></li><li>Have your child remain on the toilet for 45 minutes if possible. This will make the enema most effective. The timing of toilet sitting will vary for each child.</li><li>When finished, rinse the enema bag with water and flush the Foley catheter with soapy water through the 60 mL syringe. You can reuse these supplies.</li></ol><h2>Tips for successful antegrade continence enemas</h2><ul><li>An ACE solution should take 15 minutes to flow through your child.</li><li>The higher you hold the bag, the faster the solution will flow. The lower you hold it, the slower the flow.</li><li>If your child starts to get cramps, it is a sign that the solution is flowing too quickly. Slow down the flow by lowering the enema bag or using the roller clamp.</li><li>Try to distract your child during the enema.</li><li>Try to involve your child in the ACE to increase their independence over time.</li><li>Check the results of the ACE by looking into the toilet. If there is no stool or only a tiny amount of stool, tell your child's nurse. Your child may need a different ACE solution.</li><li>Replace the Foley catheter every two to three weeks or when it becomes clogged with stool. </li></ul><h2>What to do if the antegrade continence enema is not effective for 24 hours</h2><p>If your child is still soiling, your nurse will help you adjust the amount of enema solution and timing of enemas. </p><p>If the ACE is not effective for 24 hours, your child might need more saline solution or you might need to add liquid glycerin. Please ask your health-care team how much saline and glycerin to use.</p><h2>How to protect your child's stoma when they are not receiving an ACE</h2><p>Your doctor may suggest that you place an ACE stopper in the passage when the ACE is not being given. The stopper can be secured to the abdomen with a bandage and should be replaced every month. Your child's surgeon will tell you what size ACE stopper your child will need and where you can buy it.</p><h2>At SickKids</h2> <p>Supplies for antegrade continence enemas are sold at the Specialty Food Shop on the main floor of the hospital.</p><h2>Source</h2><p>Cincinnati Children's Hospital Medical Center (2014). <em><a href="http://www.cincinnatichildrens.org/service/c/colorectal/treatments/bowel-management/">Bowel Management Program</a></em></p>Antegrade continence enema with appendicostomy (Malone antegrade continence enema - MACE)False