Colostomy care

Colostomy stoma care

1. COLOSTOMY CARE By Manju Mulamoottil Abraham

2. Meaning & Purpose Colostomy - A surgical procedure in which the colon is shortened to remove a damaged part and the cut end diverted to an opening in the abdominal wall. Colostomy care- The pouch, stoma, and skin surrounding the stoma require care and maintenance . Purpose: To maintain integrity of stoma and peristomal skin . To prevent infection . To promote general comfort and positive self-image . To provide clean ostomy pouch for fecal evacuation . To reduce odor from overuse of old pouch .

3. Indication for Colostomy Birth defect Inflammatory bowel disease Injury to the colon or rectum Partial or complete intestinal or bowel blockage Rectal or colon cancer Wounds or fistulas in the perineum

4. Colostomy types

5. Location of Stoma The ascending colostomy is located on the right side of the abdomen. The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body Descending or sigmoid colostomy is located on the lower left side of the abdomen.

6. What to expect ? Ascending colostomy Transverse colostomy Descending colostomy Sigmoid colostomy Liquid Digestive enzyme Semi solid Digestive enzyme Resembles normal bowel movement Resembles normal movement

7. Assessment Size: Round - measure using stoma measuring guide Oval - measure length and width Colour: Red - adequate blood supply Pale - low haemoglobin Dark red/purplish tint - indicates bruising Grey to black - no blood supply Other - Appearance healthy - Shiny & moist

8. Assessment - Peristomal skin Colour Healthy - no difference from adjacent skin surface Erythema - red Bruised - purplish to yellowish colour Integrity Intact - no breakdown in skin Macerated - white friable skin, too much moisture Erosion - superficial skin damage Rash - an outbreak of lesions on the skin Ulceration - a wound through the dermis layer Other - Turgor normal (soft, good elasticity) Flaccid - weak flabby, firm - hard

9. Assessment- Stoma Stoma Colour: Normal - Pink/red/warm to touch Abnormal - black/dusky/pale/sloughy Skin: Normal - In the post-operative period the stoma can be quite swollen. It may reduce in size for about 6 weeks after surgery. Abnormal - Any sudden or unexplained swelling of the stoma Bleeding Stoma: Normal - A slight smear of blood on the wipe when washing or drying the stoma. Abnormal - Excessive bleeding when cleaning the stoma/blood in the pouch/bleeding from inside the stoma.

10. Pre- procedure preparation Detailed history taken down: current complaint, history of presenting illness, past medical history (co-morbidities), surgical history, social and environmental history. Medications and allergies documented.

11. Procedure Measure the stoma if the ostomy is new or use the previously cut pattern. Place pattern on the back of the ostomy bag and draw the proper size opening. Do not cut more than one bag for next ostomy change if the stoma is still shrinking. Place a finger inside the bag to prevent cutting through the bag when cutting the hole into the wafer. The wafer should fit just around the stoma in order to minimize the amount of skin exposed.

12. You should not apply the wafer if too much skin is left exposed to stool drainage. You can always cut the wafer larger if it is too small at first. Empty contents of bag. Remove old bag and stoma wafer, by using adhesive remover or gently pulling bag away from skin and placing your hand on the skin to decrease pulling on the skin. The skin may look dark pink when the bag is first removed. This fades quickly.

13. Discard the bag. Put the bag in a small "baggie" before putting it in the trash. Pat the skin around the stoma with gauze soaked in normal saline. Inspect the skin for signs of rash, irritation or breakdown. When skin is clean and dry, apply skin prep ( as prescribed) around the stoma site and let dry until it gets sticky. Warm the wafer attached to the bag by gently rub it between your hands to help the wafer mold to the skin.

14. Touch the skin around the stoma. Reapply the skin prep if the skin is longer sticky. Take the paper off the back of the wafer and place the bag around the stoma. Gently press the bag in place with your hand to help the wafer mold to skin. Smooth out end of bag, fold it two times and put on the clamp if the bag does not have a Velcro closure. If the edges of the wafer are not sticking to the skin: - Rub skin prep on the edges of wafer. - Use mesh tape (as prescribed) to tape the edges of the wafer to the skin.

15. Health education Black or dark gray in color (necrotic): this usually indicates a lack of adequate blood supply to the stoma and requires immediate intervention. Bleeding: the stoma may have suffered trauma or your child may have internal bleeding. Obstructed: blockage of ostomy seen by a small amount to no stool .

16. Warning Signs & Complications Warning signs: ! Bleeding from stoma. ! Bleeding from the skin around the stoma. ! Change in the bowel pattern. ! Change in the stoma size. ! Increased in the temperature Complications: ! Leakage. ! Prolapse. ! Obstruction or stenosis. ! Stoma become edematous and enlarged.

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