1. Do a cleansing rectal enema the day after discharge and every 2 days after that, until irrigations started.
                
   If enemas not previously used, follow whatever bowel routine used prior to the insertion of cecostomy tube.
              
2. Flush cecostomy tube with 10 mls of warm tap water twice daily until irrigations started.
         
3. May take acetaminophen (Tylenol) (15mg/kg) if local discomfort persists.
                 
4. Continue Flagyl (metranidazole - 10mg/kg) until all prescription has been taken.
             
5. Wash tube site with soap and water: apply polysporin to site for 1 week. Keep site covered with a small dressing. Expect some drainage for a few months. Keep retention sutures strings wrapped snuggly around gauze "sausage". These strings should be cut after 14 days.
           
6. Always keep the tube taped to the skin.
                 
7. Following a high fibre diet and drinking 8 glasses of water daily is extremely important to maintain soft form stool consistency. This allows the irrigations to completely empty the bowel.

After 1st week - ongoing care:

1. One week after discharge, begin irrigating the bowel through the C-tube:

• Instill ______ mls of phosphate Fleet enema® solution (comes in 130 ml bottle) (Johnson & Johnson · Merk or Pharmascience)
• After 15 minutes, instill _______ mls of salt water solution (lukewarm tap water with 1 tsp table salt in 500 mls water)
• Firmly massage abdomen in colckwise direction to help with bowel emptying.

2. If cramping, nausea, or vomiting occur during the procedure, please call to discuss a change of protocol.
            
3. If the tube should come out, do not panic. Simply, very gently, put the soft foley catheter into the hole. Then apply tape to keep it in place. Do not inflate the balloon, as it may damage the tract. Call the Interventional Radiology Department and arrange to have the tube reinserted.
                
4. If unable to insert the foley catheter, please call the main hospital phone and have the Interventional Radiology Fellow or Staff paged.
             
5. Please call the cecostomy nurse with any questions or concerns. If unable to reach them in an amergency, follow instruction in #4 above.      

The patients are discharged with orders to flush the catheter twice daily with 10 ml of water. They continue with their normal regime of rectal enemas on the day after discharge and for one week after that. At one week post discharge, irrigations are begun. This includes initially the administration of phosphate enema at 2 ml/kg to a maximum of 130 ml (Frost, Dorval, Quebec, Canada), followed by saline solution which is made by the patient by mixing a teaspoon of table salt with a litre of water. The saline is administered 15 minutes after the phosphate enema. Most patients require 200-300 ml of saline. The entire procedure is performed with the patient comfortably seated on a toilet. The saline antegrade enema is continued until the bowel drainage is clear. The patients are sent home with dressings, tape, polysporin, two feeding bags, silicone Foley catheters and Emla cream. The dressings are performed daily. Other orders include a high fiber diet including bran and decreasing constipation type foods such as bananas and cheese. At 14 days post procedure, the retention sutures are cut and the patient’s activity is no longer restricted.