Performing colostomy irrigation involves instilling water through a stoma to regulate bowel movements, promoting predictable evacuation and enhancing quality of life for patients with descending or sigmoid colostomies.
Definition
Colostomy irrigation is a way to regulate bowel movements by emptying the colon at a schedule time.
Purpose
- To clean colon.
- To establish regular pattern of evacuation.
- To prevent excoriation of skin around stoma.
- To observe stoma and surrounding skin.
- To teach patient and family about care of colostomy, especially if colostomy is permanent.
Articles
A tray containing:
- Irrigation can with tubing and clamp.
- Rectal catheter and funnel.
- Irrigation sleeve.
- Jug with solution at body temperature.
- Lubricant.
- Clean cotton swabs.
- Rag pieces/paper tissues.
- Dressing articles.
- Protective ointments such as zinc oxide.
- Protective sheet/mackintosh.
- Clean gloves and colostomy bag.
- Wash cloth.
- Soap.
- Towel and clean linen.
- Kidney tray and paper bag.
- Receptacle with disinfecting lotion for soiled linen.
- Bedpan/bucket for return flow.
PROCEDURE
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Assess the frequency of defecation, character of stool, and placement of stoma, as well as nutritional pattern. | Indicates the need to irrigate and stimulate elimination function. |
| 2. | Assess the time when patient normally irrigates colostomy. In case of new colostomy, confer with the physician about when irrigation can begin. Obtain written order. Confer with the patient for best time to irrigate. | Maintains established routine for bowel emptying. Bowel must be totally healed so irrigation fluid will not cause perforation. Irrigation will initiate attempt to establish regular bowel emptying. This usually occurs 3-7 days after surgery. |
| 3. | Review orders for diagnostic or surgical procedures involving the bowel. | Procedures may indicate the need to cleanse bowel of fecal contents or delay in starting irrigation procedure. |
| 4. | Explain the procedure to the patient. Help the patient to understand parts of the colostomy irrigation kit. | Helps in obtaining cooperation of patient. |
| 5. | Assemble equipment and close curtains or door. | Optimizes use of time and conserves patient’s and nurse’s energy. Provides privacy. |
| 6. | Position the patient: On toilet, or in chair in front of toilet, if ambulatory. On side of bed with head slightly elevated, if unable to be out of bed. | Allows for the placement of irrigation sleeve into toilet or bedpan. |
| 7. | During procedure Don gloves | Reduces the risk of transmission of microorganisms. |
| 8. | Remove used pouch by gently pushing skin from adhesive and barrier. Properly dispose off used pouch. Remove gloves and wash hands. | Prevents skin irritation and controls odor in room. |
| 9. | Apply irrigation sleeve over stoma. Distal end of the sleeve should rest in water in toilet or in bedpan. | Directs flow of stool into toilet or bedpan and also controls odor and splashing. |
| 10. | Fill irrigation bag with 1000 mL warm tap water, clear tubing of air, hang bag no higher than patient’s shoulder height or 18-20 inches above stoma. | 500-1,000 mL are sufficient to distend the colon and effect evacuation. Start with 500 mL. Cold water could trigger syncope, hot water could damage stoma and intestinal mucosa. Air entering the colon may trigger cramping. Raising the bag to 18-20 inches above stoma allows water to slowly enter colon and avoids cramping. |
| 11. | Apply gloves, lubricate cone tip, and hold snugly against stomal opening. Do not force the cone into stoma. Start inflow of water. Adjust direction of cone to facilitate inflow of water. | Lubricating tip prevents trauma to stoma. Gentle flow of water avoids perforation of bowel. Aiming the flow of water toward the direction of bowel aids in flow. |
| 12. | Allow water to flow in over 5-10 minutes period. | Avoids rapid distention of bowel, which triggers cramping. If cramping or nausea occurs, stop the inflow of water until it subsides and have patient take a few slow deep breaths. |
| 13. | After the desired amount of water has entered the colon, clamped the tubing and waited 15 seconds before removing the cone. | Avoids sudden backflow of water from the stoma. |
| 14. | Allow 15-20 minutes for initial evacuation, dry the tip of sleeve, and clamp the bottom. Fold the sleeve up and leave the top cover in place for 30-45 minutes. Discard gloves, patient may walk around. | Clamping the sleeve prevents leakage and optimizes evacuation of stool. |
| 15. | Don gloves, unclamp sleeve, empty any fecal contents, remove sleeve, rinse with liquid cleanser and cool water. Hang sleeve to dry. | Maintains sleeve in clean condition for future use. |
| 16. | Apply new colostomy pouch or stoma covering as per procedure. | Avoids accidental leakage, soiling of clothes, skin irritation, etc. |
| 17. | After procedure Remove gloves and wash hands. | Reduces the risk of transmission of microorganisms. |
| 18. | Inspect the volume and character of fecal material and fluid that returns after irrigation. | Determines if water is retained. If the patient is dehydrated, bowel may absorb irrigation solution. Character and amount of stool reveal success in evacuation. |
| 19. | Note patient’s response during irrigation. Ask if cramping or abdominal pain is felt. | Reveals tolerance of irrigation. |
| 20. | Record the procedure, time of irrigation, volume and type of solution if water is used, amount and type of return, and patient’s tolerance. | Documents procedure and results, data used for comparison for future irrigation. |
| 21. | Record reapplication of pouch and condition of stoma and skin. | Enables communication between staff members. |
| 22. | Report symptoms of extreme discomfort, onset of severe diarrhea, poor results or excessive bleeding to nurse in charge or physician. | Indicates the need for additional therapy. |
Special Considerations
- Debilitated confused or unconscious patients are at risk for constipation or impaction. Irrigate only with physician’s order if obstruction is suspected.
- Only patients with stoma in the lower descending or sigmoid colon are candidates for colostomy irrigation for routine bowel evacuation.
- Use of tube without a cone tip carries higher risk of perforation of colon.
- Patients who develop diarrhea should discontinue irrigation until stool thickens. Diet, medication, radiation, chemotherapy, bacterial infection, and other factors can cause diarrhea.
- Slow down the flow rate if cramping occurs.
- In case of bedridden patients, head of bed should be elevated 45-90° and place chucks* around the patients.
*Chucks are bed pads/sheets of ultra-absorbent fabric designed to lie atop wheelchairs, bedding,etc.
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
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