colostomy care in nursing practice

1. DEMONSTRATION
ON
COLOSTOMY CARE
MR. SAM ASIR SUGANTHARAJ.R,
M.SC(N),
DEPT OF MEDICAL SURGICAL
NURSING,
SHNC.

2. OSTOMY
 An ostomy is the surgery to create an
opening between an internal organ and
the body surface.

3. Types of intestinal ostomies
gastrostomy,
Jejunostomy,
Ileostomy,
Colostomy.

6. Gastrostomy
 It is an opening through the abdominal
wall into the stomach.

7. Jejunostomy
 Opens through the abdominal wall
into the jejunum.

8. ileostomy
 Opening of the abdominal wall into the
ileum.

9. COLOSTOMY
 Opening of the abdominal wall into
the colon

10. PURPOSE OF BOWEL
OSTOMIES To divert the bowel to an opening in the
abdomen
 To drain faecal material,
Bowel diversion ostomies are classified
according to their:
 Status ie: temporary or permanent.
 Anatomic location,
 Construction of stoma.

11. COLOSTOMY
 Colostomy is a surgical procedure that
brings one end of the large intestine
out through an opening (stoma) made
in the abdominal wall.
 Stools moving through the intestine
drain through the stoma into a bag
attached to the abdomen.

12. Types of colostomy
TRANSVERSE
A. LOOP
B. DOUBLE BARREL
ASCENDING
DESCENDING
SIGMOID

13. TRANSVERSE COLOSTOMIES
 Transverse colostomies
 The transverse colostomy is in the
 upper abdomen,
 either in the middle or toward the right
side of the body.
 This type of colostomy allows the stool to
leave the body before it reaches the
descending colon.

15. LOOP COLOSTOMY
 The loop colostomy may look like one
very large stoma, but it has 2
openings.
 One opening puts out stool, the other
only puts out mucus. .

17. DOUBLE-BARREL
COLOSTOMY
 In a double-barrel colostomy, the
surgeon divides the bowel completely.
 Each opening is brought to the surface as
a separate stoma.
 The 2 stomas may or may not be
separated by skin.
 one opening puts out stool and the other
puts out only mucus
 (this smaller stoma is called a mucus
fistula).

19. ASCENDING COLOSTOMY
 The ascending colostomy is placed
on the right side of the belly.
 Only a short portion of colon
remains active. This means that the
output is liquid and contains many
digestive enzymes.
 A drainable pouch must be worn at
all times, and the skin must be
protected from the output.

21. Descending and sigmoid
colostomies In the descending colon, the descending
colostomy is placed on the lower left side of the
belly.
 Most often, the output is firm and can be
controlled.
 A sigmoid colostomy is the most common type
of colostomy.
 It’s made in the sigmoid colon, and located just a
few inches lower than a descending colostomy.
 Because there’s more working colon, it may put
out solid stool on a more regular schedule.

23.  Both the descending and the sigmoid
colostomies can have a double-barrel or
single-barrel opening.
 The single-barrel, or end colostomy, is
more common.
 The stool of a descending or sigmoid
colostomy is firmer than the stool of the
transverse colostomy.

26. PERMANENT COLOSTOMY
 Blockage
 Injury
 Colorectal cancer
 Colonic polyps
 Diverticulitis
 Imperforate anus
 Irritable bowel syndrome
 Ulcerative colitis

28. ARTICLES REQUIRED FOR
COLOSTOMY CARE
 A clean tray containing
 Mackintosh with draw sheet,
 Kidney tray / paper bag ,
 Pair of clean gloves,
 Colostomy bag,
 Normal saline / basin with warm tap water,
 Gauze pieces,
 Gauze pad / tissue paper,
 Skin barrier,
 Stoma measuring guide,
 Pen or pencil and scissors.
 Bed pan.

29. ASSESSMENT
1. Identify the type & location of
ostomy in the patient.
2. Assess the skin integrity around the
stoma and appearance.
3. Note the amount and character of
fecal material in pouch.

30. PROCEDURE
 Arrange the all necessary articles.
 Explain the procedure to the patient.
 Provide privacy and assist patient to a
comfortable position.
 Wash hands & wear gloves to prevent infection.
 Spread Mackintosh & draw sheet to protect linen
 Remove used pouch & skin barrier gently by
pushing the skin away from the barrier.
 Reduces trauma,jerking, irritates skin and can
cause tear.
 Remove clamp and empty the contents into the
bed pan.rinse the pouch with tepid water or
normal saline to minimize the odour & growth of
microbes
 Discard the disposable pouch in paper bag.

31. PROCEDURE
 Observe stoma for
 colour,
 swelling,
 trauma,& healing. Stoma should be moist and pink
 Cover the stoma with a gauze piece to prevent the
fecal matters from contacting with skin
 Clean stomal region gently with warm tap water
using gauze pad.
 Do not scrub the skin, dry completely by patting the
skin with gauze.
 Remove gauze and clean stoma with gauze and pat
dry.
 Measure the stoma using measuring guide.

32.  Ensures accuracy in determining correct pouch
size needed.
 Trace same circle behind the skin barrier, using
scissors, cut an opening 1/16th to 1/8th inch larger
than stoma before removing the wrapper over
adhesive part.
 Put skin barrier and pouch over the stoma, and
gently press on to the skin, for 1-2 minutes.
 To prevent irritation to skin.
 Use the pouch if it is drainable using a clamp or
clip
 Remove gloves and wash hands.
 Make the patient comfortable
 Clean the area and replaceall articles.

33. Guidelines
 Keep odour as free of odors as possible.
 Ostomy bag should be emptied frequently.
 Check the stoma regularly, the colour
should be dark pink to red and moist.
 Pale colour indicates anaemia,
 Dark or purple blue indicates
compromised circulation.

35.  Size of the stoma stablizes 6-8 weeks.
 If dressing, check frequently for drainage and
bleeding.
 Keep the skin around the stoma (peristomal
area) site clean and dry.
 If not it causes skin irritation and infection.
 Intake and out put chart must be recorded for
every 4 hours.
 Encourage the patient to participate in care
and to look at the ostomy.
 Can help the patient by listening, explaining,
being available and supportive.

36.  Encourage the patient to avoid fibre
rich diets.
 Encourage the patient to drink fluids.
 Educate the patient about the various
methods of odor control measures.
 Chlorophyll rich diet will deodorise the
feces.
 Direct contact sports and heavy lifting
must be avoided.

41. Drainable pouch
 Drainable pouches
are generally used
when the output
will need to be
drained frequently,
e.g. ileostomies.
 Special drainable
pouches with a tap
outlet are used for
urostomies.

42. One piece pouch
 One-piece
pouches, as the
name suggests,
are all in one piece,
i.e. the whole thing
is removed when
the pouch is
changed.

43. Two-piece pouch
 Two-piece pouches – available for all
types of stoma – have a separate
base plate flange to which a pouch is
fitted.
 The base plate flange is left in place
on the abdomen, with a new pouch
fitted when necessary. Every 2-4 days
the base plate flange will need to be
changed too.

44. DOCUMENTATION
 Record the
procedure with
following details
(with date & time ).
 Amount,
 colour,
 and consistency of
the fecal matter in
the pouch.