ostomies

Ostomy Care

Whether the ostomy is temporary or permanent, the patient should be assured that it will be possible to carry on normal activities with a minimum of inconvenience. Prior to being discharged from the hospital, the patient and/or family should be provided full explanation and demonstration of ostomy care. Consultation with another patient who has become competent in ostomy care will be esp. helpful. Those individuals may be contacted through ostomy clubs that have been organized in various cities. The patient should be provided with precise directions concerning places that sell ostomy care equipment. Detailed instructions for care and use of ostomy devices are included in the package.

Specific care involves the stoma (enterostomal care) and irrigation of the bowel, when appropriate, leading to the stoma. In caring for a double-barrel colostomy, it is important to irrigate only the proximal stoma.

Stoma Care

The character of the material excreted through the stoma will depend on the portion of the bowel to which it is attached. Excretions from the ileum will be fluid and quite irritating to skin; those from the upper right colon will be semifluid; those from the upper left colon are partly solid; and those from the sigmoid colon will tend to be solid. Care of the stoma, whether for ileostomy or colostomy, is directed toward maintaining the peristomal skin and mucosa of the stoma in a healthy condition. This is more difficult to achieve with an ileostomy than with a lower colon colostomy. The skin surrounding the stoma can be protected by use of commercially available disks (washers) made of karaya gum or hypoallergenic skin shields. The collecting bag or pouch can be attached to the karaya gum washer or skin shield so that a watertight seal is made. The karaya gum washers can be used on weeping skin, but the skin shields cannot. New skin will grow beneath the karaya gum. The stoma may require only a gauze pad covering in the case of a sigmoid colostomy that is being irrigated daily or every other day. If a plastic bag is used for collecting drainage, it will need to be emptied periodically and changed as directed. At each change of the bag, meticulous but gentle skin care will be given. The stoma should not be digitally dilated except by those experienced in enterostomal care.

Irrigation of Colostomy

Many individuals will be able to regulate the character of their diet so that the feces may be removed from the colonic stoma at planned intervals. The stoma is attached to a plastic bag held in place with a self-adhering collar or a belt. Tap water at 40°C (104°F), is introduced slowly through a soft rubber catheter or cone. The catheter is inserted no further than 10 to 15 cm, and the irrigating fluid container is hung at a height that will allow fluid to flow slowly. The return from the irrigation may be collected in a closed or open-ended bag. The latter will allow the return to empty into a basin or toilet. The return of fluid and feces should be completed in less than one-half hour after irrigating fluid has entered the bowel.

At the completion of the irrigating process, the skin and stoma should be carefully cleaned and the dressing or pouch replaced. The equipment should be cleaned thoroughly and stored in a dry, well-ventilated space. When irrigation of an ostomy is provided for a hospitalized patient, charting is done on the amount and kind of fluid instilled, the amount and character of return, the care provided for the stoma, the condition of the stoma, and if a pouch or bag is replaced.

Miscellaneous Considerations

Odor may be controlled by avoiding foods that the individual finds to cause undesirable odors. Chlorophyll or bismuth subgallate tablets may control odor as well. Gas may be controlled by avoiding foods known to produce gas, which will vary from patient to patient, and with the use of simethicone products. The diet should be planned to provide a stool consistency that will be neither hard and constipating nor loose and watery. The patient may learn this by trial and error and by consulting with nutritionists and ostomy club members. Daily physical activity, sexual relations, and swimming are all possible.