Colostomy Procedure
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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 patient and answer any questions. 1 . Relieves anxiety and promotes compliance. 2 . Select a consistent time, free from 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. 2 . Establishes regularity. 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 solution so the bottom of the reservoir is approximately at the 4 . Height of irrigation bag regulates pressure of irrigant.
description
DefinitionOstomy 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.PurposeA 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.DescriptionSurgery 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.PreparationAs 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
Transcript of Colostomy Procedure
Irrigating a Colostomy
EQUIPMENTReservoir for irrigating fluids; irrigator bag or enema bag if irrigator bag not availableIrrigating 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 beltLarge tail closureWater-soluble lubricant
PROCEDURENursing Action RationalePreparatory phase1.
Explain the details of the procedure to the patient and answer any questions.
1.
Relieves anxiety and promotes compliance.
2.
Select a consistent time, free from 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.
2.
Establishes regularity.
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 solution so the bottom of the reservoir is approximately at the level of the patient's 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.
4.
Height of irrigation bag regulates pressure of irrigant.
Performance phase1.
Remove pouch or covering from stoma, and apply irrigation sleeve, directing the open tail
1.
Allows water and feces to flow directly into commode.
into the commode.2.
Open tubing clamp on the irrigating reservoir to release a small amount of solution into the commode.
2.
Removes air from the setup; avoids air from being introduced into the colon, which can cause crampy pain.
3.
Lubricate the tip of the cone/catheter, and gently insert into the stoma. Insert catheter no more than 3 inches (7.5 cm). Hold cone/shield gently, but firmly, against stoma to prevent backflow of water.
3.
Prevents intestinal perforation and irritation of mucous membranes.
4.
If catheter does not advance easily, allow water to flow slowly while advancing catheter. NEVER FORCE CATHETER. Dilating the stoma with lubricated, gloved pinky finger may be necessary to direct cone/catheter properly.
4.
Slow rate relaxes bowel to facilitate passage of catheter.
5.
Allow water to enter colon slowly over a 5- to 10-minute period. If cramping occurs, slow flow rate or clamp tubing to allow cramping to subside. If cramping does not subside, remove cone/catheter to release contents.
5.
Cramping may occur from too rapid flow, cold water, excess solution, or colon ready to function.
6.
Hold cone/shield in place 10 seconds after water is instilled, then gently remove cone/catheter from stoma.
6.
Discourages premature evacuation of fluid.
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 more minutes while patient gets up and moves around.
8.
Ambulation stimulates peristalsis and completion of irrigation return.
9.
When returns are complete, clean stomal area with mild soap and water; pat dry; reapply pouch or covering over stoma.
9.
Cleanliness and dryness promote comfort.
Follow-up phase1.
Clean equipment with soap and water; dry and store in well-ventilated area.
1.
This will control odor and mildew, prolonging the life of equipment.
2.
If applicable, the patient should use a pouch until the colostomy is sufficiently controlled.
2.
It may take several months to establish control. The patient can then use minipouch, stoma cap, or gauze covering as desired.
