A colostomy is a surgical opening from the colon through the abdominal wall to the outside of the body. The purpose is for waste products (stool) to leave the body. A colostomy is performed for a variety of reasons including cancer, infections and certain diseases. Occasionally, the colostomy is only temporary until the colon heals and then it is reversed, but most of the time a colostomy is permanent. 1. Empty the colostomy drainage bag several times each day. It’s best to empty the bag before it gets too full to prevent leaks and spills. 2.
Remove the old colostomy bag by detaching it carefully from the skin every four to six days and discard it. 3. Thoroughly clean the skin around the stoma and dry thoroughly. The skin around the stoma where the bag is attached is very tender and must be kept clean and dry. 4. Apply antibiotic powder as directed to the skin around the stoma to help prevent irritation and yeast infection. 5. Replace the skin barrier disk or paste to the tender skin around the stoma. 6. Attach a new colostomy bag carefully over the stoma. 7. Order ostomy supplies to be delivered as needed.
Colostomies are performed for various reasons, including trauma, blockage and infection. The procedure is quite intense and requires a commitment to colostomy aftercare by the patient, nursing staff and doctors. Caring for a colostomy patient requires you to have knowledge and compassion. Conditions such as diverticulitis, inflammatory bowel disease, cancer or trauma sometimes require a colostomy. In general, the surgery lasts two to four hours. The most common type of colostomy procedure is the Hartmann colostomy, a procedure in which the colon is cut in half.
The end of the colon that leads to the stomach is fed through the abdomen wall and attached to the skin. This area is the stoma. After surgery, the end of the colon near the rectum grows dormant. Most colostomies performed can be reversed after the affected tissues of the colon heal. In the days following surgery, you should check the stoma’s appearance to ensure that it remains red and moist. If there is any change in color, especially a darkening to a purple or black tone, you should immediately share this information with the surgeon.
Check the abdomen for distention or bleeding near the incision site. Intake and output must be monitored to reduce the patient’s risk of dehydration or electrolyte imbalance. Within six to eight weeks, the swelling will reduce, and the stoma will shrink to its normal size. The stoma and surrounding skin should be assessed on a routine basis. Note the color and height of the stoma, and look for skin damage such as blisters, ulcers or rashes. Patients with certain types of colostomies — descending or sigmoid — might choose not to wear a pouch and opt for irrigation instead.
To prepare for irrigation, the colostomy patient should take a seat on the toilet. Insert a flexible catheter coated in water-soluble jelly no more than 3 inches (7. 6 cm) into the stoma. Stop at the first sign of resistance. If necessary, use a gloved and lubricated finger to dilate the stoma. After the catheter is in place, 16. 9 to 33. 8 ounces (500 to 1,000 cc) of warm fluid fills the colon. If the colostomy patient experiences cramping, the fluid flow should be stopped until cramping subsides and then continued slowly. The fluid remains in the colon for a few minutes before being drained into the toilet.
Sometimes side-to-side or back-and-forth movement will encourage the fluid return rate to increase if slowed. The colostomy patient should note the amount and fluid type returned after irrigation. Any obstruction or prolapse of the stoma must be reported immediately. Patients who must use a pouching system can choose between disposable or reusable and one-piece or two-piece. In the one-piece system, the wafer and pouch are connected and attach to the stoma site. The wafer and pouch are separate in the two-piece system. The wafer attaches to the skin and the pouch to the wafer.
The colostomy patient should weigh the advantages and disadvantages of each system. To change the colostomy bag, carefully remove the attached system. Be gentle with the wafer removal. Adhesive remover can be used to prevent skin breakdown. The area around the stoma should be cleaned and dried. Take note of any skin damage, and seek proper treatment for the patient in the case of rash, blistering or fungal infection. Apply sealant to the skin surrounding the stoma and apply the new wafer. To keep the abdomen flat, the colostomy patient might find that standing works best.
Place the wafer against the skin. The stoma should fit through the hole with a ring of space between the stoma and the wafer. Use your finger to apply pressure to the wafer and ensure proper skin adhesion. Connect the pouch to the wafer. A clicking sound will occur when the plastic circles seal. Place the tail closure on the open end of the pouch. Colostomy patients should tell their doctors about any abdominal pain, fever or skin irritation. A change in bowel habits or a hernia — often appearing as a bulge around the stoma — requires further medical care.
Problems with leaking at the stoma site or a desire for a different pouch system can be easily solved by a visit with a physician. Tips for colostomy care Applying Your Pouch * You may stand or sit to apply your pouch. * Keep the skin where you apply the pouch wrinkle-free. If the skin around the pouch is wrinkled, the seal may break when your skin stretches. * If hair grows close to your stoma, you may trim off the hair with scissors, an electric razor, or a safety razor. * Always have a mirror nearby so you can get a better view of your stoma. * When you apply a new pouch, write the date on the adhesive tape.
This will remind you of when you last changed your pouch. Changing Your Pouch * The best time to change your pouch is in the morning, before eating or drinking anything. Your stoma can function at any time, but it will function more after eating or drinking. Emptying Your Pouch * Empty your pouch when it is one-third full (of urine, stool, and/or gas). If you wait until your pouch is fuller than this, it will be more difficult to empty and more noticeable. * When you empty your pouch, either put toilet paper in the toilet bowl first, or flush the toilet while you empty the pouch. This will reduce splashing.
You can empty the pouch between your legs or to one side while sitting, or while standing or stooping. If you have a 2-piece system, you can snap off the pouch to empty it. Remember that your stoma may function during this time. * If you wish to rinse your pouch after you empty it, a turkey baster can be helpful. When using a baster, squirt water up into the pouch through the opening at the bottom. With a 2-piece system, you can snap off the pouch to rinse it. After rinsing your pouch, empty it into the toilet. * When rinsing your pouch at home, put a few granules of Dreft soap in the rinse water.
This helps lubricate and freshen your pouch. * The inside of your pouch can be sprayed with non-stick cooking oil (Pam spray). This may help reduce stool sticking to the inside of the pouch. Bathing * You may shower or bathe with your pouch on or off. Remember that your stoma may function during this time. * The materials you use to wash your stoma and the skin around it should be clean, but they do not need to be sterile. Wearing Your Pouch * During hot weather, or if you perspire a lot in general, wear a cover over your pouch. This may prevent a rash on your skin under the pouch.
Pouch covers are sold at ostomy supply stores. * Wear the pouch inside your underwear for better support. * Watch your weight. Any gain or loss of 10 to 15 pounds or more can change the way your pouch fits. Going Away From Home * A collapsible cup (like those that come in travel kits) or a soft plastic squirt bottle with a pull-up top (like a travel bottle for shampoo) can be used for rinsing your pouch when you are away from home. Tilt the opening of the pouch at an upward angle when using a cup to rinse. * Carry wet wipes or extra tissues to use in public bathrooms.
* Carry an extra pouching system with you at all times. * Never keep ostomy supplies in the glove compartment of your car. Extreme heat or cold can damage the skin barriers and adhesive wafers on the pouch. * When you travel, carry your ostomy supplies with you at all times. Keep them within easy reach. Do not pack ostomy supplies in baggage that will be checked or otherwise separated from you, because your baggage might be lost. If you’re traveling out of the country, it is helpful to have a letter stating that you are carrying ostomy supplies as a medical necessity.
* If you need ostomy supplies while traveling, look in the yellow pages of the telephone book under “Surgical Supplies. ” Or call the local ostomy organization to find out where supplies are available. * Do not let your ostomy supplies get low. Always order new pouches before you use the last one. Reducing Odor * Limit foods such as broccoli, cabbage, onions, fish, and garlic in your diet to help reduce odor. * Each time you empty your pouch, carefully clean the opening of the pouch, both inside and outside, with toilet paper.
* Rinse your pouch 1 or 2 times daily after you empty it (see directions for emptying your pouch and going away from home). * Add deodorant (such as Super Banish or Nullo) to your pouch. * Use air deodorizers in your bathroom. * Do not add aspirin to your pouch. Even though aspirin can help prevent odor, it could cause ulcers on your stoma. When to call the doctor Call the doctor if you have any of the following symptoms: * Purple, black, or white stoma * Severe cramps lasting more than 6 hours * Severe watery discharge from the stoma lasting more than 6 hours * No output from the colostomy for 3 days
* Excessive bleeding from your stoma * Swelling of your stoma to more than 1/2-inch larger than usual * Pulling inward of your stoma below skin level * Severe skin irritation or deep ulcers * Bulging or other changes in your abdomen When to call your ostomy nurse Call your ostomy/enterostomal therapy (ET) nurse if any of the following occurs: * Frequent leaking of your pouching system * Change in size or appearance of your stoma, causing discomfort or problems with your pouch * Skin rash or rawness * Weight gain or loss that causes problems with your pouch