Instructions for Temporary (Initial) Cecostomy Tube Placed in Interventional Radiology (IR)

Important information about the temporary cecostomy tube:

This tube/catheter is placed into the first part of the large bowel, called the cecum. The cecum is in the right, lower abdomen. It is used to give an enema quickly and empty the large intestines through the anus. For the initial placement, a “pigtail” catheter will be used. Your child will return to IR in 6 weeks and your child’s temporary cecostomy tube will be changed to a Chait Trapdoor™ cecostomy tube at that time.

Instructions for care of the temporary cecostomy tube:

  • Always keep the cecostomy tube taped to your child’s abdomen. It is important to keep the exit site of the temporary cecostomy tube covered and clean.

  • Change the dressing once a week. Change the dressing sooner if it becomes loose, wet, or dirty.

  • For the first two weeks after your procedure, do NOT perform any antegrade enemas. You can start antegrade enemas after your 2 week post-op visit. 

Gather your supplies:

  • 2 - Clean washcloths

  • Soap

  • Water

  • Antibiotic ointment (if prescribed)

  • 2- split gauze

  • 2x2 gauze

  • Dressing cover or tape (as directed)

Remove the old dressing.

  1. Wash your hands with soap and water. Dry well.

  2. Carefully remove the old dressing. Pull gently on the dressing. Do not pull on the cecostomy tube or the bolster sutures.

  3. Check the exit site and area around the tube. If you see any of the following call Interventional Radiology (IR):

    • Tenderness

    • Redness

    • Itching

    • Swelling

    • Discharge

    • Unraveling of sutures or loose sutures

    • Also call if your child has pain at the site.

Clean the exit site.

  		1.

    Wash your hands again with soap and water. Dry well.

  2. Clean around the exit site with washcloth, soap, and water. Start cleaning from center and work outward in a circular motion.

  3. Gently pat the site dry.

  4. Apply antibiotic ointment if it is prescribed by your healthcare provider.

Apply the new dressing.

  1. Wash your hands with soap and water. Dry well.

  2. You will see suture threads wrapped snugly around a roll of gauze called a bolster. Slide 1 split gauze under the bolster and around the cecostomy tube.

  3. Slide 2nd split gauze around cecostomy tube and over the bolster.

  4. Place 2x2 gauze on top of the split gauze and cecostomy tube.

  5. Apply dressing over the 2x2 gauze as you were taught.

  6. Wash your hands with soap and water. Dry well. 

Instructions for flushing the temporary cecostomy tube:

Flush the temporary cecostomy tube with normal saline twice daily. 

Gather your supplies:

  • 10 mL syringe

  • Alcohol pad

  • Normal saline

  1. Wash your hands with soap and water. Dry well.

  2. Draw up 10 mL normal saline into syringe.

  3. Remove alcohol pad from package.

  4. Rub the cap of the cecostomy tube with the alcohol pad.

  5. Attach the saline syringe to the cap.

  6. Push the plunger on the syringe to gently flush 10 mL normal saline into tube. If it does not flow easily, stop flushing and contact IR immediately.

  7. Disconnect the syringe and throw away.

  8. Wash your hands with soap and water. Dry well.

Instructions for giving an enema through the temporary cecostomy tube: 

Your child will follow up with IR about 2 weeks after your initial cecostomy tube placement. At that time, IR will decide if you may use the cecostomy tube to give enemas. Until that time follow the bowel care ordered by your healthcare team. 

Gather your supplies: 

  		•

    2 – gravity bags with roller clamp

  • Drainage bag connector

  • Hook to hang bag

  • Saline

  • Phosphate enema solution

  1. Wash your hands with soap and water. Dy well.

  2. Add ordered amount of phosphate solution to first bag.

  3. Add ordered amount of saline to second bag.

  4. Have your child sit on the toilet.

  5. Wash your hands with soap and water. Dry well.

  6. Remove alcohol pad from package.

  7. Rub cap on the cecostomy tube with alcohol pad.

  8. Attach drainage bag connector to cap of cecostomy tube. 

  9. Remove cap from the tubing on the phosphate bag. Connect tubing to drainage bag connector. 

  10. Open the roller clamp and allow the phosphate solution to flow in.

  11. When the phosphate solution bag is empty, close the clamp. Wait 15 minutes.

  12. After 15 minutes, remove the phosphate bag and set aside. Immediately attach the second gravity bag containing normal saline

  13. Open the roller clamp on the saline bag and allow saline solution to run in. This usually takes about 5 minutes.

  14. When the saline bag is empty, close the clamp. Disconnect the bag and set aside.

  15. Remove drainage bag connector and set aside. Do not throw away the gravity bags or the drainage bag connector. You will wash them and use them again.

  16. Wash your hands with soap and water. Dry well.

  		17.

    Your child should continue to sit on toilet and wait for the bowel to empty. This may take 30-40 minutes. Massaging the abdomen firmly from left to right may help empty the bowel faster.

  18. Rinse gravity bags and drainage bag connector with warm water and then wash with soap and water. Allow bags to completely air dry before storing.

Discharge instructions:

Your child will be discharged from the hospital about several days after the temporary cecostomy procedure.

  • Sutures: You will see suture threads wrapped snugly around a roll of gauze called a bolster. If sutures become loose or unraveled, call IR.

  • Activity: While sutures are in place your child cannot participate in any physical activity. After sutures are removed there are no activity restrictions.

  • Appointments: You will need to schedule 2 appointments in IR (See contact information on last page):

    • Schedule a 2 week follow up appointment for suture removal.

    • Schedule a 6-week follow-up appointment to change the temporary tube to the Chait Trapdoor cecostomy tube.

  • Bathing: For the first 2 weeks after the procedure, your child may take a shower or sponge bath. They may not take a tub bath. The dressing must be changed if it gets wet.

  • Medicine: Your child must take their antibiotics as directed and for as long as prescribed by your healthcare provider.

  • Diet: Your child should follow a high fiber diet. Drinking lots of water keeps the stool soft. Avoid constipating foods.

Contact CHOP interventional radiology team with questions, concerns, or if your child has:

  • Fever higher than 101°F (38.3 C).

  • Bleeding or swelling at the site.

  • Pus leaking at the site.

  • Sudden, increased, or severe abdominal pain.

  • An enema that will not flow into cecostomy tube.

  • No bowel movement after the enema is given or if enema fluid does not come out.

  • Pain or vomiting with the enema.

  • If your child’s tube becomes dislodged or falls out, call IR immediately. If unable to reach IR go to the emergency room.

Interventional Radiology

  • 8 AM – 4:30 PM, Monday through Friday, call 215-590-7000. At the first prompt, push 1 and at the second prompt push 2.

  • At all other times call 215-590-1000 and ask to speak to the interventional radiologist on call.