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Colostomy Procedure

Definition Ostomy is a surgical procedure used to create an opening for urine and feces to be released from the body. Colostomy refers to a surgical procedure where a portion of the large intestine is brought through the abdominal wall to carry stool out of the body. Purpose A colostomy is created as a means to treat various disorders of the large intestine, including cancer, obstruction, inflammatory bowel disease, ruptured diverticulum, ischemia (compromised blood supply), or traumatic injury. Temporary colostomies are created to divert stool from injured or diseased portions of the large intestine, allowing rest and healing. Permanent colostomies are performed when the distal bowel (bowel at the farthest distance) must be removed or is blocked and inoperable. Although colorectal cancer is the most common indication for a permanent colostomy, only about 10-15% of patients with this diagnosis require a colostomy. Description Surgery will result in one of three types of colostomies: * End colostomy. The functioning end of the intestine (the section of bowel that remains connected to the upper gastrointestinal tract) is brought out onto the surface of the abdomen, forming the stoma by cuffing the intestine back on itself and suturing the end to the skin. A stoma is an artificial opening created to the surface of the body. The surface of the stoma is actually the lining of the intestine, usually appearing moist and pink. The distal portion of bowel (now connected only to the rectum) may be removed, or sutured closed and left in the abdomen. An end colostomy is usually a permanent ostomy, resulting from trauma, cancer or another pathological condition. * Double-barrel colostomy. This colsotomy involves the creation of two separate stomas on the abdominal wall. The proximal (nearest) stoma is the functional end that is connected to the upper gastrointestinal tract and will drain stool. The distal stoma, connected to the rectum and also called a mucous fistula, drains small amounts of mucus material. This is most often a temporary colostomy performed to rest an area of bowel, and to be later closed. * Loop colostomy. This colostomy is created by bringing a loop of bowel through an incision in the abdominal wall. The loop is held in place outside the abdomen by a plastic rod slipped beneath it. An incision is made in the bowel to allow the passage of stool through the loop colostomy. The supporting rod is removed approximately 7-10 days after surgery, when healing has occurred that will prevent the loop of bowel from retracting into the abdomen. A loop colostomy is most often performed for creation of a temporary stoma to divert stool away from an area of intestine that has been blocked or ruptured. Preparation As with any surgical procedure, the patient will be required to sign a consent form after the procedure is explained thoroughly. Blood and urine studies, along with various x rays and an electrocardiograph (EKG), may be ordered as the doctor deems necessary. If possible, the patient should visit an enterostomal therapist, who will mark an appropriate place on the abdomen for the stoma, and offer pre-operative education on ostomy management. In order to empty and cleanse the bowel, the patient may be placed on a low residue diet for several days prior to surgery. A liquid diet may be ordered for at least the day before surgery, with nothing by mouth after midnight. A series of enemas and/or oral preparations (GoLytely or Colyte) may be ordered to empty the bowel of stool. Oral anti-infectives (neomycin, erythromycin, or kanamycin sulfate) may be ordered to decrease bacteria in the intestine and help prevent post-operative infection. A nasogastric tube is inserted from the nose to the stomach on the day of surgery or during surgery to remove gastric secretions and prevent nausea and vomiting. A urinary catheter (a thin plastic tube) may also be inserted to keep the bladder empty duri

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4K views2 pages

Colostomy Procedure

Definition Ostomy is a surgical procedure used to create an opening for urine and feces to be released from the body. Colostomy refers to a surgical procedure where a portion of the large intestine is brought through the abdominal wall to carry stool out of the body. Purpose A colostomy is created as a means to treat various disorders of the large intestine, including cancer, obstruction, inflammatory bowel disease, ruptured diverticulum, ischemia (compromised blood supply), or traumatic injury. Temporary colostomies are created to divert stool from injured or diseased portions of the large intestine, allowing rest and healing. Permanent colostomies are performed when the distal bowel (bowel at the farthest distance) must be removed or is blocked and inoperable. Although colorectal cancer is the most common indication for a permanent colostomy, only about 10-15% of patients with this diagnosis require a colostomy. Description Surgery will result in one of three types of colostomies: * End colostomy. The functioning end of the intestine (the section of bowel that remains connected to the upper gastrointestinal tract) is brought out onto the surface of the abdomen, forming the stoma by cuffing the intestine back on itself and suturing the end to the skin. A stoma is an artificial opening created to the surface of the body. The surface of the stoma is actually the lining of the intestine, usually appearing moist and pink. The distal portion of bowel (now connected only to the rectum) may be removed, or sutured closed and left in the abdomen. An end colostomy is usually a permanent ostomy, resulting from trauma, cancer or another pathological condition. * Double-barrel colostomy. This colsotomy involves the creation of two separate stomas on the abdominal wall. The proximal (nearest) stoma is the functional end that is connected to the upper gastrointestinal tract and will drain stool. The distal stoma, connected to the rectum and also called a mucous fistula, drains small amounts of mucus material. This is most often a temporary colostomy performed to rest an area of bowel, and to be later closed. * Loop colostomy. This colostomy is created by bringing a loop of bowel through an incision in the abdominal wall. The loop is held in place outside the abdomen by a plastic rod slipped beneath it. An incision is made in the bowel to allow the passage of stool through the loop colostomy. The supporting rod is removed approximately 7-10 days after surgery, when healing has occurred that will prevent the loop of bowel from retracting into the abdomen. A loop colostomy is most often performed for creation of a temporary stoma to divert stool away from an area of intestine that has been blocked or ruptured. Preparation As with any surgical procedure, the patient will be required to sign a consent form after the procedure is explained thoroughly. Blood and urine studies, along with various x rays and an electrocardiograph (EKG), may be ordered as the doctor deems necessary. If possible, the patient should visit an enterostomal therapist, who will mark an appropriate place on the abdomen for the stoma, and offer pre-operative education on ostomy management. In order to empty and cleanse the bowel, the patient may be placed on a low residue diet for several days prior to surgery. A liquid diet may be ordered for at least the day before surgery, with nothing by mouth after midnight. A series of enemas and/or oral preparations (GoLytely or Colyte) may be ordered to empty the bowel of stool. Oral anti-infectives (neomycin, erythromycin, or kanamycin sulfate) may be ordered to decrease bacteria in the intestine and help prevent post-operative infection. A nasogastric tube is inserted from the nose to the stomach on the day of surgery or during surgery to remove gastric secretions and prevent nausea and vomiting. A urinary catheter (a thin plastic tube) may also be inserted to keep the bladder empty duri

Uploaded by

marie
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Irrigating a Colostomy

EQUIPMENT
Reservoir for irrigating fluids; irrigator bag or enema bag if irrigator bag not
available
Irrigating fluid: 500-1,500 mL lukewarm water or other solution prescribed by
health care provider (Volume is titrated based on patient tolerance and
results; average amount is 1,000 mL.)

Irrigating tip: Cone tip or soft rubber catheter #22 or #24 with shield to
prevent backflow of irrigating solution (Use only if cone not available. The
cone is the preferred method to avoid possibility of bowel perforation.)

Irrigation sleeve (long, large-capacity bag with opening at top to insert cone
or catheter into stoma); available in different styles: Snap-on, self-adhering
to skin, or held in place by belt
Large tail closure
Water-soluble lubricant

PROCEDURE
Nursing Action Rationale
Preparatory phase
1 Explain the details of the procedure to the 1 Relieves anxiety and
. patient and answer any questions. . promotes compliance.
2 Select a consistent time, free from 2 Establishes regularity.
. distractions. If the patient is learning to .
irrigate for bowel control, choose the time of
day that will best fit into the patient's
lifestyle.
3 Have the patient sit in front of the commode
. on chair or on the commode itself, providing
privacy, and comfort.
4 Hang irrigating reservoir with prescribed 4 Height of irrigation bag
. solution so the bottom of the reservoir is . regulates pressure of
approximately at the level of the patient's irrigant.
shoulder and above the stoma.
Note: Colostomy irrigation may also be
performed to empty the colon of its contents
(feces, gas, mucus) before a diagnostic
procedure or surgery and to cleanse the colon
after fecal impaction removal or with
constipation.

Performance phase
1 Remove pouch or covering from stoma, and 1 Allows water and feces to
. apply irrigation sleeve, directing the open tail . flow directly into commode.
into the commode.
2 Open tubing clamp on the irrigating reservoir 2 Removes air from the setup;
. to release a small amount of solution into the . avoids air from being
commode. introduced into the colon,
which can cause crampy
pain.
3 Lubricate the tip of the cone/catheter, and 3 Prevents intestinal
. gently insert into the stoma. Insert catheter . perforation and irritation of
no more than 3 inches (7.5 cm). Hold mucous membranes.
cone/shield gently, but firmly, against stoma
to prevent backflow of water.
4 If catheter does not advance easily, allow 4 Slow rate relaxes bowel to
. water to flow slowly while advancing catheter.. facilitate passage of
NEVER FORCE CATHETER. Dilating the stoma catheter.
with lubricated, gloved pinky finger may be
necessary to direct cone/catheter properly.
5 Allow water to enter colon slowly over a 5- to 5 Cramping may occur from
. 10-minute period. If cramping occurs, slow . too rapid flow, cold water,
flow rate or clamp tubing to allow cramping excess solution, or colon
to subside. If cramping does not subside, ready to function.
remove cone/catheter to release contents.
6 Hold cone/shield in place 10 seconds after 6 Discourages premature
. water is instilled, then gently remove . evacuation of fluid.
cone/catheter from stoma.
7 As feces and water flow down sleeve,
. periodically rinse sleeve with water. Allow 10-
15 minutes for most of the returns, then dry
sleeve tail and apply tail closure.
8 Leave sleeve in place for approximately 20 8 Ambulation stimulates
. more minutes while patient gets up and . peristalsis and completion
moves around. of irrigation return.
9 When returns are complete, clean stomal 9 Cleanliness and dryness
. area with mild soap and water; pat dry; . promote comfort.
reapply pouch or covering over stoma.

Follow-up phase
1 Clean equipment with soap and water; dry 1 This will control odor and
. and store in well-ventilated area. . mildew, prolonging the life
of equipment.
2 If applicable, the patient should use a pouch 2 It may take several months
. until the colostomy is sufficiently controlled. . to establish control. The
patient can then use
minipouch, stoma cap, or
gauze covering as desired.

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