Administration of High-Volume Enema Using a Foley Catheter

In this training video, a gastroenterology nurse at The Children’s Hospital of Philadelphia demonstrates how to give a high-volume enema to your child using a Foley catheter.

Start by gathering your supplies — an enema bag, connection device, Foley catheter with balloon, 10 ml luer-locking syringe, lubricating jelly and a tape measure. Have your child lay on his left side and in the bathroom, if possible.

Now test your supplies, ensuring the balloon will inflate as needed, and measuring the Foley catheter to 4 inches to ensure proper placement in your child. Once the enema bag is connected to the Foley catheter, close the clamp, then add the amount of saline that your child’s clinician directed.

Next, lubricate the tip of the Foley catheter. Insert it into your child’s rectum in a twisting motion to minimize discomfort. Once the catheter is inserted to the 4-inch mark, inflate the balloon with air, then allow the infusion solution to flow into your child.

The balloon acts as a plug during the infusion. Once your child’s body has absorbed the solution, wait another 10 minutes, then deflate the balloon, remove the catheter from his rectum and have your child sit on the toilet for 30-45 minutes until the colon is cleaned out.

Enemas are not painful, but they can be uncomfortable and cause some abdominal cramping.

Transcript

Enema – Foley Catheter

Nicole: The second delivery method we're going to discuss is a Foley catheter. With that, we're going to gather your supplies. We're going to use an enema bag. You're going to need a connection device and you're going to need a Foley catheter. The size of the Foley catheter will be determined by your physician. This is a 24 French Foley catheter. This Foley catheter has a balloon. You're also going to need a 10 ml or 10 cc luer lock syringe, lubricating jelly and a tape measure.

One of the first things that you're going to do is to take your Foley catheter and test your balloon. The reason why we administer these types of enemas are again retention enemas. The balloon, once it's inflated inside the rectum, is going to retain the fluids of the saline enema inside the rectum so that there isn't any leakage or seeping around the catheter.

We're going to take our 10 cc luer lock syringe. We have to fill it up with air, and the way we do that, we pull back on the plunger until you get to the number 10. You're going to attach the syringe to the end of the balloon port of the Foley catheter. The way to attach the syringe is to press down and turn clockwise to the right. You're now going to infuse the balloon with air. This balloon will need to be infused with 15 milliliters of air. You're going to remove the luer lock syringe off of the catheter and pull back an additional 5 milliliters. Again, place it on the top of the balloon portion, turn it clockwise, and infuse.

While you are maintaining pressure on the syringe, you're going to twist off counter clockwise and remove the syringe. The reason you need to maintain pressure while removing the syringe is that had you not maintained pressure, the air from the balloon would actually deflate.

So, now we're going to remove the air that we place in the balloon. We've already tested it. We made sure that the supplies are functioning. So we're going to remove the air by attaching the syringe and pulling back on the syringe to remove the air. And if you see, it's now deflated.

So, inserting the Foley catheter, you need to know how far to insert it. So, you're going to need a measuring devise and we are going to measure 4 inches from the tip of the catheter and mark it. This is how far you will insert the catheter. Now, we have the enema bag here. This is your standard enema bag that comes with a sliding clamp, again to adjust the flow of the saline, roller clamp open, roller clamp closed. You'll need both hands to actually close this roller clamp.

The tip of the enema bag already comes pre-lubricated and if you notice, there are holes here. Because we won’t be using this tip of the enema bag, we'll actually be using this tip of the Foley, we'll need to remove this section of the bag. We'll take a pair of scissors, cut. There's no rhyme or reason to the length that you'll need to cut, you'll just want to get rid of the end portion that contains the holes. You're now going to take the end of the enema bag and connect it to the Foley. The device that we need to connect it to, we need to use a clear connecting device; otherwise, these two devices will not connect securely.

We will take the connecting device. One end will go into the enema bag. The other end will connect to the Foley. You want to make sure these are secure. And now you have your system.

So, again, we're in the bathroom, we're on the floor, we have towels, we have Johnny, he's comfortable. First thing that we'll do, close our slider clamp. We're going to add fluids in. We're going to use the same number as previously used, we'll use 500. Now, this bag is a little bit trickier to use because the opening is a little bit smaller, so be careful and certainly you can prime it over your sink.

Now that we have the connection secure, we're going to prime the bag. The way that we do that is open the slider clamp. That will allow fluids to go and purge through the tubing, to the end of the catheter. You'll need to use both hands for this section. The fluids will prime pretty quickly.

The fluids have been primed through. Remember, the higher the bag, the faster the flow. Now, we're ready to begin. Remember, that after the enema has infused, we have to stay in this position for an additional 10 minutes so that the solution fluids will be retained in Johnny's rectum.

We're going to lubricate the tip of the Foley catheter. We're going to separate the buttock and insert the catheter. I find it very helpful when inserting a Foley catheter or an enema of any sort, it's easier to tolerate if you insert the catheter with a twisting motion as opposed to a straight insertion. It just makes it easier for the children to tolerate.

We're going to insert it to our mark. Now, this should not be uncomfortable for Johnny. He will feel the catheter, but he shouldn't feel any discomfort. Once the catheter is in place, we're going to inflate the balloon. If you remember how to do this, we're going to pull back the air to 10, attach the syringe, while applying pressure, remove the syringe. We'll pull up an additional 5 milliliters, attached the syringe, apply pressure and remove. If you noticed, we are now taut inside of Johnny's rectum. Now, it's time to infuse the solution.

While the fluids are infusing, you'll want to hold the catheter so that it doesn't migrate back and forth inside Johnny's rectum. If it were to migrate inside further, it wouldn't cause any damage, your fluids would just leak out. Once the infusion has completed, you're going to hold the catheter in place for a period of 10 minutes. It has now been 10 minutes and it's time to remove the Foley catheter.

Very important step: You must first remove the air out of the balloon. We're going to attached the syringe and withdraw the air. So, what would happen if you did not remove the air from the balloon? It could also - it could cause some discomfort and you would not be able to remove the catheter.

So, I am feeling some tension because all of my air is empty out of my balloon. So, again, first thing remove the air out of the balloon. Now it's time to remove the catheter. Now it's time for Johnny to sit on the commode for a period of 30 to 45 minutes.

Topics Covered: Enema Administration

Related Centers and Programs: Kohl’s GI Nutrition and Diagnostic Center, Division of Gastroenterology, Hepatology and Nutrition