Colostomy Care

Colostomy is the opening of some portion of the colon onto the abdominal face

Reasons for Performing a Colostomy

• When feces cannot progress naturally from the colon to the anus
• When it is more desirable or manageable to divert the feces, as for paraplegics
• In any condition where the rectum or anus is nonfunctional because of disease, a birth defect or a traumatic condition.
• It is performed to divert the fecal flow away from an area of  inflammation or around an operative area

General Procedure for Changing an Ostomy Pouch

Assessment

1. Identify the type of ostomy the patient has and its location (Bowel Urinary Diversion)
2. Assess the skin integrity around the stoma and as general appearance
3. Note the amount and character of any fecal material or urine in the pouch
4. Determine whether the patient is being taught self-care at the moment

Planning

1. Wash your hands
2. Gather the equipment needed in changing a pouch or dressing

• Cleansing supplies including tissues, warm water, mild soap, wash cloth and a towel
• Clean pouch of the type currently being used
• Seal or use tape to prevent leakage
• Clean belt
• Dressing materials
• Receptacle for the soiled pouch or dressing (bedpan, paper bag/newspaper for wrapping)
• Protective spray
• Clean gloves

1. Determine whether the patient is to participate actively
2. Choose the appropriate location in performing the procedure (bathroom/ bedside)

Implementation

1. Identify the patient
2. Explain the procedure to the patient
3. Put on clean gloves for infection
4. Assist the patient to the bathroom or provide privacy
5. Remove the soiled dressing
6. Using warm water and a mild soap, cleanse the skin around the stoma thoroughly. Inspect the skin for redness or irritation.
7. Cover the stoma with a tissue to prevent feces or urine from contacting. Change tissues as necessary during the procedure
8. Dry the skin around the stoma carefully, patting gently
9. Apply a skin protective spray if needed
10. Allow the skin to dry thoroughly so the pouch will adhere firmly (a hair dryer on a low setting at least 18 inches from the skin may be used)
11. Remove the tissue from the stoma and apply the clean pouch or dressing
12. Remove gloves and wash hands

Evaluation

1. Evaluate using the following criteria

• Pouch or dressing secure
• Area clean
• Odor free
• Patient comfortable
• If the patient is being taught the procedure, add the following criteria:
  • Patient is able to change pouch using correct technique
  • Patient verbalizes understanding of key points in care

Documentation

1. Record the following information:

• The amount, color, and consistency of the fecal material or urine in the pouch
• The application of the clean pouch and dressing change
• The knowledge and ability of the patient t participate in the procedure or ability to change independently.