Colostomy Topics in this Section

colostomycare A colostomy is a reversible surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel for feces to leave the body. Colostomies are often used in cases of Imperforate Anus and other conditions where there is a defect in the colon or large intestine.

Colostomy Care
Pouch Selection
Pouch systems are available in many styles and sizes. They consist of a sticky wafer that adheres to the skin and a pouch to collect the stool. There are one piece systems and two piece systems. A one piece pouch has the wafer and pouch joined together as a single unit. A two piece system has a wafer and pouch that are separate. Pouches are available with an opened or closed end. Open end pouches are used most commonly as they allow you to easily drain the pouch of air and stool. Open end or "drainable" pouches require a clip on the end to keep them sealed. This is called a "tail closure". There are additional supplies that may be required including stoma paste and stoma powder. The surgical nurse will help determine the best pouch system and supplies required to suit your child's needs post operatively. With time and experience your child's needs may change and a different pouch system and supplies can be ordered. Pouches & supplies are provided by a supply company with a physician's order. Most of these companies ship supplies directly to your home. Please be certain to contact the company when your child's supplies run low to allow adequate time for the order to be filled & shipped.

Emptying the Pouch

In general, you should be certain your child's pouch is emptied frequently. Pouches that are allowed to become full are heavy and can pull away from the skin. If this occurs the pouch system will need to be replaced. Procedure

Empty the pouch when it is 1/3 full of air or stool. This may be done at the time of a diaper change, or if you child is older, he or she can sit on the toilet. Hold the end of the pouch up before removing the clip. This allows you to control the flow of stool draining out of the pouch. Stool can be drained into a container, a diaper or, directly into the toilet. Lay a piece of toilet tissue on the water before draining the pouch to minimize splashing. Hints

After emptying the pouch, wipe the end inside and out before closing. You can use toilet paper or a wet wipe. Cleaning will prevent odor once the pouch is sealed. After cleaning, close the pouch as usual. Liquid deodorant can be ordered for the pouch. Emptying the pouch is a good time to inspect the integrity of the wafer and the pouch. If it is loose or leaking, the system must be changed to prevent stool from irritating the skin around the stoma. Empty the pouch prior to naptime or before your child goes to bed at night.

Changing the Pouch

The frequency of pouch changes depends on many things. Ideally a pouch should last one to several days between changes. If the pouch must be changed more than once a day, call our office or your home care nurse for advice. A good time to change a pouch is before a meal or several hours after eating, when the stoma is draining less. If your child experiences irritation or discomfort of the stoma area, it may mean there is stool leaking onto the skin & causing irritation. If this happens, change the pouch right away. Supplies

Appropriate size pouch: one or two piece Permanent marking pen Tail closure, if needed (clip that keeps pouch closed) Template (pattern) for stoma Scissors Skin cleansing supplies As needed: Stoma paste and small syringe Deodorant for pouch Stoma powder Adhesive remover or mineral oil Belt, if using Cavilon 3M no sting barrier film Procedure

Carefully remove old pouch with mineral oil, or alcohol free adhesive remover. Wash and set aside the re-usable clip. Clean skin gently. You may give your child a tub bath or shower with the pouch off. Observe the stoma for changes in size & color. A slight amount of bleeding from the stoma can be normal. Evaluate condition of surrounding skin. If the stoma is round, use the precut template to find a pattern that fits best. A good fit means there should is no skin visible around the stoma. Date the template. If the stoma is irregular in shape, use a firm piece of clear plastic to trace a pattern of the stoma. Use this as your template. Date the template. Use the template to trace an opening on the wafer, the adhesive portion of the pouch. Cut out your tracing with sharp scissors. Do not cut beyond the cutting guide. Smooth out rough edges with your finger. Warm the wafer in your hand to soften. Apply Cavilon 3M no sting barrier film to skin around stoma If the pouch has 2 pieces, you can attach the pouch to the wafer now, or attach the pouch after the wafer is applied to the skin. Remove the paper backing from the wafer. If you are using paste, apply sparingly to the wafer around the hand cut opening or apply to the skin where it meets the stoma. Press the pouch on to the skin using light pressure with your hand. This will promote a secure attachment. Apply clip to end of pouch. Empty the pouch when 1/3 full of air or stool. Change the entire pouch when the wafer comes loose from the skin. Do not flush pouch or wipes down the toilet. Hints

Templates need to be checked for size frequently, especially when the stoma is new, because the stoma may change in size. A template that is too large will lead to damaged skin immediately around the stoma. A template that is too small will irritate the stoma. Stoma paste is especially useful to fill in areas around the stoma that are uneven and may cause the pouch to leak. Paste is also helpful when placed immediately next to the stoma, to minimize leaking. Do not use too much, it may be difficult to remove. Stoma powder helps dry out any ulcerated or eroded skin. Too much powder can prevent the pouch from sticking. Be sure to blow off excess after application and rub in well to ensure that the pouch will stick. Areas of skin that are irritated or damaged will benefit from a pouch that adheres well to the skin & does not leak. The irritated skin will heal under the pouch quickly if it remains covered & protected from stool.

Diaper Method For Sigmoid Colostomy

To be used when stools are thick and pasty, usually from the descending colon. Supplies

A barrier paste such as Butt Balm or Ilex Paste. Skin barrier Soft and thick paper towels. Surgical tape Cavilon 3M no sting barrier film Procedure

Clean around stoma well with warm water. A bath is very soothing to the skin & will not harm the stoma. Apply Cavilon 3M no sting barrier film to skin around stoma Cover the area surrounding the stoma with a thick (1/8 - 1/4 inch) layer of the Ilex or Butt Balm paste. Cut two large strips of the skin barrier to fit on either side of the applied paste. Fold the paper towels in quarters and apply to cover the stoma and paste. Tape towel to skin barrier strips with tape. Change the paper towel as needed. Remove stool from paste & apply more paste and a paper towel. Diaper as usual. Remove all the paste from skin every day with mineral oil and/or a tub bath. This is a good time to check the skin around the stoma. Do not flush wipes down the toilet.

Colostomy Preoperative Procedures

Colostomy Preoperative Procedures
Preparation for colon surgery begins a few days prior to the procedure unless the surgery is being done on an emergency basis, such as for an injury or intestinal bleeding. Most patients have undergone a colonoscopy, sigmoidoscopy, or barium enema to diagnose the disease. These tests generally are not repeated. Prior to the operation, blood tests, a chest x-ray, an EKG, and an abdominal CT scan may be ordered. The colon contains bacteria and waste products that can cause infection if they leak into the abdomen during surgery and precautions are taken to reduce this risk. Oral antibiotics are started several days before the operation is scheduled and the colon must be as empty as possible. The procedure for colon cleansing depends on the physician, the patient's health and diagnosis, and the facility where the procedure is being performed. Generally, for 2 or 3 days prior to surgery, a soft or semiliquid diet (i.e., foods that are quickly and easily digested) is ordered. For some patients, only clear liquids are permitted. These include fruit juice, sports drinks, clear broth, and gelatin. All patients must go on a clear liquid diet 24 hours prior to surgery. After midnight, the night before surgery, nothing may be taken by mouth. Article Continues Below Ads by Google Polycom Telemedicine Reduce Bandwidth by up to 50%And Save on Costs. Find out more. www.Polycom-Campaign.com/healthcare

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Cleansing solutions and laxatives are used to cleanse the colon before surgery. Patients are given a laxative solution to drink that can cause severe diarrhea, so they may be admitted to the hospital the day before the surgery to receive intravenous fluids that prevent dehydration. If the patient is unable to comply with this regimen, it is necessary to inform the physician as soon as possible. It may be unsafe to do the surgery as scheduled and it may have to be postponed. During this period, it may not be possible to continue prescription medications. This must be discussed with the surgeon as soon as the decision to have the surgery is made. Blood "thinning" medications, including aspirin, must be discontinued one week before the operation to avoid excessive bleeding during the procedure. The anesthesiologist (doctor who administers the anesthesia) speaks with the patient prior to surgery and performs a brief physical assessment. The anesthesiologist must be aware of medications that are being taken, any history of allergies, and prior adverse reactions to anesthesia. This information helps the anesthesiologist select the most suitable anesthetic agents and dosage and avoid possible complications. An informed consent form must be signed acknowledging that the patient understands the procedure, the potential risks, and that they will receive certain medications. The patient is then taken to a preoperative holding area and must remain in bed except to use the bathroom. An intravenous (IV) is started for fluids and medication, if one is not already in place. A sedative is given through the intravenous to induce drowsiness. Anesthesia is administered in the operating room.