Ostomy Care and Irrigation

Elimination: Ostomy CareTerms:Ostomy-a surgically created opening into the

bodyStoma-opening to the outside of the body.

Location is determined by the part of the colon that is injured or diseased.

Ileostomy- permanent artificial opening in the ileum (refer to the graph on page 201 in the text)

Elimination-TerminologyCecostomy-permanent artificial opening in

the cecumrefer to the graph on page 201 in the text)Colostomy-most common type of ostomy.

Permanent artificial opening in the large intestine.

Bowel Diversions- other methods of bringing the intestines to the abdominal wall to preserve its vitality while avoiding non-functioning and/or ill intestines

Elimination- StomaA normal Stoma should appear:Meaty redMoistsmoothThe stoma is actual intestinal tissuePeri-skin should be clean and dry with no s/s

of infection or irritation

Elimination: Stool SpecimenProcedures for the Different Types of Specimen

Collections:Stool:Receive instructions from RNGather supplies (to include specimen container

and label)Explain procedure to the patient (inform not to put

toilet paper or urine in the collection apparatusObserve standard precautionsUse tongue blade to remove approx 2 Tablespoons

of stool from the collection apparatus and place into the specimen container

Complete ending procedures

Elimination: Urine SpecimenUrine: Receive instructions for the RN Gather equipment (to include sterile specimen container

and label) Explain procedure to patient (to include not to put toilet

paper or stool into the collection apparatus) Observe Standard Precautions

Elimination: Urine Specimen Clean peri area Use clean collection container only Measure urine from collection apparatus

into a graduated cylinder Pour from the cylinder into the specimen

container observing sterile technique with container

Complete ending procedures

Elimination: Routine Stoma CarePurpose of Routine Stoma Care: Done to keep the tissue around the stoma

healthy Waste eliminated from the stoma may be

very irritating to the tissue. The stool from an ileostomy is more acidic

than the stool from a colostomy

Elimination: Routine Stoma Care Equipment: Apply Standard Precautions- gloves Washcloth and towel and basin of warm water Disposable appliance bag, belt and adhesive

wafer Bedpan Skin lotion as directed 4x4 gauze squares Toilet tissue

Elimination: Routine Ostomy CareExplanation to patient: These patients require a lot of support and

reassurance They can be worried about strong

offensive odors They can worry about the bag showing

under their clothing You need to be very professional, tactful,

patient and understanding

Elimination: Routine Ostomy CareSkin Care: Apply standard precautions Remove the soiled disposable stoma bag and

belt Empty the appliance when it is ½ to 2/3 full If a leak develops, change the pouch

immediately. Empty the reusable bag and wash it

thoroughly with soap and water after each bowel movement

Elimination: Routine Ostomy CareSkin Care:Gently cleanse area around stoma with toilet tissueWash area around stoma with soap and water. Rinse and dry.Apply barrier around stoma if directedObserve the skin around the stoma for redness, irritation, and skin breakdown and report to the RNObserve the color, character, amount and frequency of stools and report any abnormalities.

Elimination: Routine Stoma CareRecording and Reporting:Observe the skin around the stoma for

redness, irritation, and skin breakdown, and report to the RN

Observe the color, character, amount and frequency of stools, and report abnormalities to the RN

Report any abnormalities or patient complaints to the RN

Record completion of task.

Elimination: Ileostomy CareAn ileostomy is a permanent artificial

opening in the ileum that drains through a stoma on the surface of the abdomen

The drainage from the ileum is in liquid form and contains digestive enzymes that are irritating to the skin.

The fit of the ileostomy ring is critical to prevent leakage. This is true for both disposable and reusable types of appliances.

Elimination: Ileostomy CareApply clean stoma bagThere are many different types of pouches.Reusable and disposable; One piece or two

piece.Self adhering or those that require adhesive to

be applied to the wafer.Center the pouch ring over the wafer ring and

press firmly but gently to snap the rings together.

Secure the clamp at the bottom of the bag to prevent leaking

Secure belt, ensuring that the skin beneath the belt is not irritated or broken.

Elimination: Ileostomy CareIt may be necessary to apply a clean adhesive wafer

along with the pouch When removing the wafer, apply gentle traction to

the skin next to the wafer to prevent skin irritation You may be required to cut the wafer to fit around

the stoma before applying to the skin. Cut the area 1/8 inch larger than the size of the stoma

Remove the paper backing from the adhesive wafer Seal the entire area surrounding the stoma to

prevent leaking. Holding your hand over the area for about a minute will help.

The heat from your hands promotes a good seal. Ensure the wafer is wrinkle free

Elimination: Colostomy CareColostomy is the most common type of

ostomyIt is located between the colon and the abdomenThe intestines are brought to the outside of the

body to create the stomaWhen the ostomy is first performed, the stool is

loose and watery but it becomes soft and formed over time

The function of the colon is to absorb water from the chyme for the body to use. Once the water is removed from the chyme, stool is formed.

If a portion of the colon has been removed, the body will not be able to absorb the water and the stool will be more liquid.

Elimination: Colostomy CareCare of the skin, removing and apply the

pouch and wafer is very similar to how it is done for an ileostomy

The stoma will be located in a different area on the abdomen.

Elimination: Ostomy IrrigationIrrigation is done: to regulate elimination -which can take 4-6

weeks to cleanse the bowel before tests or

proceduresThis procedure should be done by an RN on

newly created colostomies

Elimination: Ostomy IrrigationBefore beginning the procedure:Determine that you are permitted to perform

this skill on the patientIdentify the patient before beginning the

procedureExplain the procedure to the patientGather your equipmentObserve Standard Precautions

Elimination: Ostomy IrrigationGather your Equipment:2 incontinent pads, if being done in the bedBedpan, if being done in the bedIrrigation sleeve with belt or self adhesive ringIV StandardIrrigation bag with 1000cc’s warm waterGauze spongesTowelsWater –soluble lubricant

Elimination: Ostomy IrrigationPosition the Patient:Assist to the bathroom if being done on the toilet,

and have them sit on the toilet .The drainage sleeve will be positioned between

the legsIf being done in the bed, place the patient in the

supine position with head slightly elevated Position the incontinent pad to prevent soiling. Position a second pad on a chair next to the bed

and place a bedpan on the pad.The drainage sleeve will be positioned to the side

Elimination: Ostomy IrrigationProcedure:Hang irrigation bag approximately 20 inches

above the patient ( the bottom of the bag should be at about the patient’s shoulder level to prevent water from entering the bowel too quickly)

Prime the tubing if not done previouslyRemove colostomy bag and waferApply irrigation sleeve using belt or adhesive

backing

Eliminiation: Ostomy IrrigationProcedure continued:Place open end of irrigation sleeve in the

toilet or bedpan sitting on the seat of a chair beside the bed

It is important the end of the drainage sleeve not hang in the water of the toilet bowl. It may be necessary to cut the sleeve if it is too long.

Elimination: Ostomy IrrigationProcedure continued:Lubricate the gloved pinky fingerGently insert into the stoma. Determine the

bowel angle with your finger. Lubricate the irrigation cone well.Gently insert the cone in the direction of the

bowel determined by your finger.

Elimination: Ostomy IrrigationProcedure continues:Unclamp the tubing and allow the fluid to run

in slowlyAdjust the rate with the roller clamp or pinch

the tubingThe bag should flow in over 10-15 minutesWhen empty, remove the cone. Close the tip of the sleeve if the patient will

be ambulating

Elimination: Ostomy IrrigationProcedure continues:After irrigation is complete, remove the

sleeve and discardWash peri skin with warm water, rinse and

dry.Apply barrier, if directedApply clean appliancePerform procedure completion actions.

Elimination: Ostomy IrrigationCommon Problems:Patient complains of abdominal cramping Stop the flow of solution, leaving the cone in place

Cramping can be due to:air in the tubing or if the flow is too fast orThe water is too cold orThe bowel is ready to empty Trouble shoot and correct the problem then restart

the solution

Elimination: Ostomy IrrigationThe three probable signs of fecal impaction are:Seepage of liquid stool instead of formed stools This seepage may have a strong odorAbdominal DistentionAs the stool sits in the intestines, it continues to

ferment and the intestines continue to secrete mucous to try to flush the stool out, this creates a gas that expands the intestines and in turn expands the abdomen

Nausea and vomitingDue to the backing up of stool, causing a full feeling

in the stomach, the build up of gas and toxins in the intestines all lead to an upset stomach and possibly vomiting