Definition
Colostomy care refers to cleaning of the stoma area using warm water and dry wipes to gently clean around the stoma.
A colostomy is a surgically created opening in the abdominal wall through which digested food and stool passes through the stoma into a pouch attached to the stoma on the outside of abdomen. The pouch, the stoma and skin surrounding the stoma require care and maintenance by patient or caregiver.
Purpose
- To prevent leakage.
- To prevent excoriation of skin and stoma.
- To observe stoma and surrounding skin.
- To teach patient and relatives about care of colostomy and collection bag.
Articles
A tray containing:
- Rubber sheet.
- Long sheet.
- Towel.
- Clean gloves.
- Cotton swabs and gauze pieces.
- Wash cloth.
- Water in basin.
- Soap in dish.
- Disposable colostomy bag with clamp.
- Stoma measuring guide.
- Zinc oxide ointment.
- Skin barrier.
- Bedpan with cover.
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Explain procedure to the patient and explain to him how he has to cooperate. | Helps in obtaining cooperation of the patient. |
| 2. | Assemble the necessary equipment nearby. | Organization facilitates performance of the task. |
| 3. | During procedure Wash hands and don gloves. | Prevents spread of microorganisms. |
| 4. | Provide privacy and assist the patient to a comfortable position (Fowler, semi- Fowler, standing, or sitting position in bathroom). | Positioning allows the patient to view the procedure in preparation for learning. |
| 5. | Empty the partially filled appliance into the bedpan if it is a drainable pouch. | Emptying the contents before removal of the pouch prevents accidental spillage of fecal material. Pouches that are full can detach and leak. |
| 6. | Remove the appliance slowly beginning at the top while keeping the abdominal skin taut. If any resistance is felt, use warm water or adhesive solvent to facilitate removal. | Careful removal protects the underlying skin from damage and minimizes discomfort for the patient. |
| 7. | Use tissue paper to remove any excess stool from the stoma. Cover stoma with a gauze pad. | Gauze absorbs any drainage from the stoma while the skin is being prepared. |
| 8. | Gently wash and pat dry the peristomal skin. Mild soap and cleansing agent may be used according to agency policy. | |
| 9. | Assess the appearance of peristomal skin and stoma. A moist reddish-pink stoma is considered normal. | Change in normal appearance may indicate anemia, altered circulation, and it should be informed to physician. |
| 10. | Apply paste type skin barrier (zinc oxide) if required and allow the paste to dry for 1-2 minutes. | Establishes a smooth surface for the application of skin barrier and pouch. |
| 11. | Apply the skin barrier and appliance together. Select the size of stoma opening by using the measurement guide. Trace same size circle on the back at the center of the skin barrier. Use scissors to cut an opening ¼ or 1/8 inch larger than stoma. Remove the backing to expose sticky side. Remove gauze pad covering stoma. Place barrier and pouch over the stoma and gently press onto skin while smoothing out creases or wrinkles. Hold the pouch in place for 5 minutes. | Placing both the skin barrier and appliance together over the stoma makes application easier for the patient. Smooth application of pouch prevents escape of odor and feces. |
| 12. | Instill deodorant in bag if required. | |
| 13. | Close the pouch if it is drainable by folding the end upward and using a clamp or clip according to manufacturer’s direction. | A tightly sealed appliance will not leak and cause embarrassment and discomfort for the patient. |
| 14. | After procedure Dispose off used equipment, discard gloves, and wash hands. | Prevents spread of microorganisms. |
| 15. | Document appearance of stoma, condition of peristomal skin, and patient’s reaction to the procedure. | Facilitates continuity of care. |
Emptying Colostomy Bag without Changing
| Empty contents into bedpan or toilet. Rinse pouch with tepid water. | Rinsing provides clean appearance and minimizes odor. |
| Wipe the lower 2 inches of the pouch with toilet tissue. | Drying the lower section of the pouch removes additional fecal material. |
| Instill deodorant in bag and uncuff the edge of the pouch and apply the clamp. | Prevents bad odor. Clamp secures closure of the appliance. |
| Dispose off used equipment, discard gloves, and wash hands. | Prevents spread of microorganisms. |
| Document the procedure and patient’s reaction to the procedure. | Ensures communication between staff members. |
Special Considerations
- Flatus may cause a pouch to balloon out. This requires immediate attention because if flatus is not released, the pouch may separate from the skin barrier causing fecal contents or release of fecal odor. Open the clamp and release the flatus (never puncture a hole in the appliance).
- Measure the patient’s fluid intake and output. Check the stoma appliance for quality and quantity of discharge. Record intake and output every 4 hours for the first 3 days following surgery.
- Stoma site should be always dry. Presence of moisture increases the chance for Candida or yeast infection.
- Return of peristalsis causes an increase in flatus. Advice patients that this is indicative of bowel functioning. Also tell them to avoid gas-containing food since there is no way to voluntarily control passing of flatus.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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