STOMA CARE ON COLORECTAL CANCER

Current updates and recommendations

Lucia Anik
TIM WOUND AND STOMA CARE RSUP DR SARDJITO
Yogyakarta, March 26th 2019
Curiculum Vitae

 Name : Lucia Anik Purwaningsih

 Phone Number/ WA : +62 81 329786169
 email : elanie_la@yahoo.com

 Education History :
◦ S2 Master of Nursing, (Twin Program Khon Kaen University Thailand - UMY
Yogyakarta) 2014
◦ ET Nurse (WOCN), InETNEP (Indonesian Enterostomal Therapy Nurse Education
Program), Twin Program Indonesia-Australia, Universitas Indonesia Jakarta,
2007
◦ S1 Ners, PSIK Gadjah Mada University, Yogyakarta 2005
◦ D3 Keperawatan, Akper Depkes Yogyakarta, 1999

 Employment History
◦ Head Nurse, Burn Unit Sardjito General Hospital
◦ Wound Consultant Sardjito General Hospital
◦ Lecturer Magister Keperawatan – PSIK FKKMK Gadjah Mada University

 Organisation
◦ Ketua InWOCNA DIY dan Jawa Tengah
◦ Professional Board InOA (Indonesian Ostomy Association) YKI – DIY
◦ Member of WCET (World Council of Enterostomal Therapy)
Session outline
I. In touch with “Stoma”

II. Problem of stoma care

III. Recent recommendation

and guidelines Stoma Care

IV. Take home messages

Latar Belakang……
Pasien dengan stoma menghadapi berbagai masalah baik
fisik maupun psikologis, seperti kebocoran yang disebabkan
kegagalan menempelnya perekat (Pratiwi, 2013)

40% pasien dengan stoma mengalami masalah kulit dan

30% mengalami kebocoran (Lynch et al,2008)

Peralatan yang sesuai merupakan hal penting untuk

mencegah kebocoran dan komplikasi (Wong, 2009)

Angka kejadian terus meningkat, Terdaftar 413 ostomate di

Indonesian Ostomate Association (InOA) dengan berbagai
indikasi pembuatan stoma (YKI, 2013)

RS.Dr.Sardjito Kasus 411, Ca Colorectal : 66 % ca recti 10 % dibuat

colostomi (IRM RSS,2015)
I. In touch with Stoma

 Stoma bukan suatu “Penyakit” tapi stoma

membantu pasien bebas dari masalah
penyakit, obstruksi dan nyeri.
 Stoma adalah "Sebuah lubang buatan yang
dibuat oleh dokter ahli bedah pada dinding
abdomen untuk mengeluarkan feses dan
sebagai life saving ”
 Prinsip perawatannya menampung output
 TIPE STOMA - LOKASI

ILEOUSTOMI DESENDEN
KOLOSTOMI

SIGMOID TRANSVERSUM
KOLOSTOMI KOLOSTOMI
Ileostomy

Ileostomy function begins within the first 48 to

72 hours

If peristalsis has returned, the ileostomy

produced a high - volume output in
adaptation phase

Reaching 1,500 to 1,800 ml/day

Monitoring the signs and symptoms of fluid

and electrolyte imbalance
Colostomy

Usually begins to function on postoperative

day 3 to 5

The output usually is a soft, formed stool

Colostomy irrigation begins after 6 weeks

postoperative
 Patient Impact
◦ Stoma berpengaruh pada keterbatasan aktivitas sehari-
hari dan pergaulan sosial (Joshland et al,2011)
◦ Pasien stoma menghadapi stress, terisolasi, harga diri
rendah, gangguan citra tubuh, dan memiliki rasa tidak
kompeten (Black, 2004)
◦ Domain spiritual buruk 81,1 % (helen, 2014)
◦ Mckenzie (2006)
 50% pasien merasa tubuh mereka berada di luar kontrol
 47% merasa hilang rasa percaya diri
 55% merasa bahwa tidak ada seorang pun yang dapat
merasakan bagaimana memiliki stoma.
 23% merasa dirinya kurang sebagai pria atau wanita
 37% khawatir terhadap penggantian kantong stoma
II. Problems of Stoma Care
Divided into 3 main areas

1. Problems in the
management of a stoma
e.g. retraction, prolapse,
stenosis, mucocutaneous
separation
2. Skin conditions which may
arise due to the stoma or
wearing of an appliance
3. Psychological and spiritual
issues
Masalah pada perawatan stoma
 Kotoran
 Bau tidak sedap
 Flatus
 Komplikasi
 Perawatan kulit sekitar
stoma
KOMPLIKASI STOMA

Retraction Prolapse Necrosis

Stenosis Hernia
 PERISTOMAL SKIN PROBLEM

Excoriation Epidermal Folliculitis

hyperplasia

How to Alkaline Contact

care……??
encrustation dermatitis
 III. Recent recommendation and guidelines Stoma
Care Management
 Team approach – specialist nurses, ward and community
nurses, medical staff, patient, carers and family
 Practical Support – how to look after the stoma and surrounding
skin, dietary advice, types of appliances, holiday advice
 Psychologic Support – emotional reaction to this type of
surgery, lifestyle issues, sexuality and body image
 Preoperative preparation including siting
 Post operative support and education
 Continued support once patient is discharged into the
community
 Aim is for the patient to become an‘expert’ in stoma
management and adapts to life with a stoma
How to care……??
 Perawatan kulit peristoma
 Pemilihan kantong stoma
 Pemasangan kantong stoma
Perkembangan Perawatan Stoma di RSUP Dr.Sardjito

OLD
TREATMENT:
STOMA BAG
WITHOUT
SKIN
BARRIER
 NOW : With Skin Barrier

Treatment:
1. Bersihkan kulit sekitar stoma
dan stoma dengan
Aquabidest
2. Keringkan , beri skin barrier
3. Beri stomahesive powder tipis
merata
4. Beri stomahesive paste utk
mencegah kebocoran
5. Pasang Stoma bag dengan
lobang sesuai ukuran stoma
KOMPLIKASI AWAL PADA STOMA
1. EXCESS BLOOD LOSS 2. GROSS EDEMA OF
STOMA TISSUE

NURSING ACTION: NURSING ACTION:

1. LEPASKAN KANTONG 1. Lepas dan evaluasi
2. IDENTIFIKASI SUMBER kantong
PERDARAHAN 2. Identifikasi penyebab
3. HENTIKAN PERDARAHAN 3. Ukur stoma, dan ukur
4. HUBUNGI DOKTER base line
5. CATAT TEMUAN DAN 4. Hindari trauma
INTERVENSI
Necrotic
CIRCULATORY FAILURE TO STOMAL TISSUE

IDENTFIKASI PENYEBAB
HINDARI TEKANAN, soft
appliance, bersihkan pelan,
hilangkan sloughs
Iritasi, maserasi, exoriasi

Action :
• Management
effluent
• Do not change
frequent
• Use powder
• Use sealed

Iritasi peristomal 18-55%

Colwell et al, 2001

 Total atau parsial
Poor healing; steroid therapi or diabetic
Lead total retraction, infection
Symptoms: pain,burning,discomfort,
purulent drainage

Action:
• Gentle cleansing
• Filler : powder, paste,
obsortif dressing
• Adhesifve strip,
tranparant film
• Two-piece system
appliance
Retraction

Action :
• Gunakan convex
ostomy bag, ikat
pinggang
• Gunakan paste
• Perbaiki faktor
penyebab
• Revisi stoma bila
diperlukan
Prolaps

In adequately rectus muscle

Insuffisient jahitan
Umumnya terjadi pada loop
stoma atau pada anak
Action:
Konservatif, kurangi tekanan
, kompres dingin, hindarkan
dari taruma, two-pice sistem
appliance,
Perhatikan tanda –tanda
incarcerata.
Stenosis
 Bagian lumen sempit
 Alkalin urine pd
urosotomi
 Efek radiasi, nekrosis,
mucocutan separasi
 Action; stoma dilatasi
 Irigasi stoma
 Awasi tanda obstruksi
, revisi bila perlu
Parastomal hernia
 Penonjolan karena
defek otot
 Outside rectus muscle
 Over weight
 Asimptomatik
Action :
Suport belts
Flexible pouching
Revisi stoma diperlukan
CAN THE OSTOMATE LIFE
LIKE BEFORE …?

Information and
Suppport
Edukasi penting pasien
stoma
Diet ; cukup serat, tidak bergas, mudah dicerna

Aktifitas; hindari OR beresiko, sosialisasi, rekreasi

Sex; komunikasi, gunakan kantong khusus

Ibadah; bersihkan sebelum ibadah

Discharge Planning Information
Stoma care instruction:
 Stoma & Peristomal skin
care
 Manage the appliance
 Diet
 Daily activities
 Travel
 Religion
 Clothing
 Seek professional help
 Storage of appliance

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Multidisiplinary Patient Support
 Healthcare Professionals
 Clinical psychology
 National and local patient support groups
e.g. Indonesian Ostomy Association (InOA-YKI
DIY)(Wiwied 08157922002, Lucia 081329786169
 One to one patient support
 Stoma appliance manufacturers, pharmacy,
dispensing appliance contractors
Faktor yang harus diperhatikan dalam
memilih kantong stoma
 Tipe stoma yang dimiliki ostomate
 Letak stoma
 Konstruksi stoma
 Kulit sekitar stoma
 Tipe dan konsistensi keluaran yang dihasilkan stoma
 Jenis dan gaya hidup klien sehari-hari
Peralatan Perawatan Peristoma

 Skin Barrier
◦ Barrier kulit
 Powder
◦ Treatment skin excoriation
◦ Absorbsi minimal exudate
 Paste
◦ Menutup lipatan kulit/rongga
◦ Mencegah kebocoran
 Stoma bag
◦ Menampung output
 PASTE

Aplikasi STOMAHESIVE PASTE di Aplikasi STOMAHESIVE PASTE di

sekeliling stoma u/ Colostomi permukaan WAFER u/ Ileostomi &
Urostomi
 Cara mengganti kantong stoma…..
1. Kosongkan stoma bag
2. Lepaskan stoma bag dari atas kebawah
3. Cuci tangan
4. Bersihkan kulit sekitar stoma, dan stoma
secara hati-hati
5. Keringkan kulit sekitar stoma sampai benar-
benar kering
6. Beri skin barrier wipe K/P
7. Ukur besarnya lobang stoma sesuaikan
dengan stoma bag
8. Pasang stoma bag dari bagian bawah,
posisikan stoma bag sesuai aktivitas pasien
9. Rekatkan secara perlahan
10. Dan Tempelkan selama 45 detik, agar
menambah daya rekat
11. Tutup ujung stoma bag dengan klem/klip
 IV. A Message To You...
Colostomy surgery is a lifesaving surgery that enables a
person to enjoy a full range of activities, including traveling,
sports, family life and work. Thousands of people annually
undergo ostomy surgery and have a stoma for various reasons
and return to a healthy, functioning lifestyle.

We invite you to join us as we fulfill our mission in helping others.

From the Indonesian Ostomate Associations (InOA) of Yogyakarta
References:
 Joshland,E.,Breannan (2011).Developing and Sustaining a Renal Supportive Care Services for
People with End Stage Renal Disease. Renal Society of Australia Journal 8(1)
 Swan, Elaine. (2010). Colostomy, management and quality of life for the patient. British Journal
of Nursing, 2010, Vol 19, No 21

 Murray,R.B. Zentner,J.P.(2003).Nursing Assesment and Health Promotion (5th

ed.p.670).Connecticut:Prentice-Hall

 Blackley,P.(2007).Practical Stoma Wound and Continence Management. Australia:Research

Publications Pty Ltd.

 Rankin,S.H. Stallings,K.D.(2001).Patient Education:Principles & Practice. (4th ed,p.46). Philadelphia :

Lippincot Williams & Williams

 Mallik,M. (2008).The Role of nurse educators in the development of reflective practitioners:a

selective case study of the Australian and UK experience. Nursing Education Today . 18,52-63.

 Burch,J.(2004).The management and care of people with stoma complications. British Journal of
Nursing ,13(6).p318.
 Grogan S. (2008). Body Image: Understanding Body Dissatisfaction in Men, Women and
ileostomy or urostomy. Sheldon Press, London
 Kelly MP, Henry T. (1992). A thirst for practical knowledge. Stoma patients’ opinions of the
services they receive. Prof Nurse7(6): 350–1, 354–6
 McKenzie F, White CA, Kendall S, Finlayson A, Urquhart M, Williams I. (2006).
Psychological impact of colostomy pouch change and disposal. Br J Nurs 15 (6): 308–16
 Black, P (2004). Psychological, Sexual and Cultur Issue for Patien with Stoma. Brithish Journal of
Nursing 13 (12).692-697

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Thank You
Lucia Anik

+62 81329786169

elanie_la@yahoo.com

Tim Wound Care RSUP Dr Sardjito Yogyakarta

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