Colostomy care

Definition

A colostomy is a surgically created opening in the abdominal wall through which digested food passes. It may be temporary or permanent. The opening is called a stoma from the Greek word meaning mouth. Stool passes through the stoma into a pouch attached to the stoma on the outside of the abdomen. The pouch, stoma, and skin surrounding the stoma require care and maintenance by the patient or caregiver.

Purpose

A pouch is worn over a colostomy to collect the stool passed through the stoma. There are a variety of pouches available for use with a colostomy. Over time the patient can determine which pouch type best suits his or her needs. A colostomy pouch is normally emptied one or more times daily. The pouch itself usually needs to be changed every four to six days. The stoma and surrounding skin need to be kept clean and sanitary.

Precautions

The nurse attending to a colostomy should wash his or her hands before and after the procedure, as well as wear latex gloves while performing care.

Description

A pouching system is normally worn over a colostomy stoma. Pouches can be obtained from several different manufacturers in both disposable and reusable varieties. The enterostomal therapy ET nurse can be an invaluable resource when helping patients select a pouch system.

Colostomy pouches may be either open ended or closed. Open-ended pouches require a clamp for closure. They can be drained simply and reused after they are emptied. Closed pouches are sealed at the bottom and are usually used by patients who irrigate their colostomies or who have a regular bowel elimination pattern. Two-piece pouch systems consist of a separate flange and pouch. The pouch has a closing ring that attaches to a matching piece on the flange. One-piece systems have a connected wafer and pouch that do not separate. The portion of the pouch that is applied to the abdomen is called a skin barrier wafer. Both two-piece and one-piece systems can be either closed or open ended.

Some patients with colostomies can irrigate their stomas using a procedure similar to an enema. This cleans the stool out of the colon through the stoma. A special irrigation system is used. Sometimes a special lubricant is used to prepare for the irrigation. Irrigating often leads to increased control over the timing of bowel movements.

Removing the colostomy appliance requires gently pushing away the skin surrounding the stoma and pulling the appliance downwards. Adhesive remover wipes are available to help in the removal of the wafer. The bag is then discarded in an appropriate waste container. The stoma should be cleaned with lukewarm water and dried with a soft towel. The stoma and surrounding skin should be assessed. The stoma should be pink or red and moist-looking, and may bleed slightly when cleansed. The stoma normally decreases in size slightly during the first weeks after surgery.

The opening in the wafer should fit snugly around the stoma. An opening that is too large will allow intestinal contents to leak onto the skin. Measuring guides come with the colostomy wafers so that the hole can be cut to the proper size. Skin barrier paste can be used to help create a better seal between the wafer and the patient's abdomen. Various skin preparation products are also available to help protect the skin under the wafer and around the stoma. They also aid in the adhesion of the wafer. Using the fingertips, gentle pressure should be applied to put the wafer in place.

After the application of the barrier, the bag should be applied (if it is a two-piece system). If it is an open system, apply a clamp to the bottom of the new pouch.

Preparation

The nurse should instruct the patient and caregiver(s) about the procedure before it is performed. Many people feel anxious and nervous when first dealing with an ostomy. Encourage the patient to ask questions, and explain all steps as they are performed.

Aftercare

The nurse should assess the patient's tolerance of the procedure and response to teaching or education about the appliance.

Health care team roles

Although most members of the health care team will come into contact with patients having ostomies, it is the nurse who has the responsibility for providing ostomy care and instructing the patient and/or caregiver how to provide care independently. An enterostomal therapy (ET) nurse is specially educated in all aspects of ostomy care.

Key Terms

StomaSurgically constructed mouth or passage between the intestine and the outside of the patient's body.