IRRIGATING A COLOSTOMY

Definition:
Colostomy irrigation is a way to remove stool without wearing a colostomy bag all the
time. You use the stoma to wash out the colon with water (like an enema). You perform this
procedure at the same time every day, or every other day, depending on your needs.
Colostomies can be temporary or permanent. Ostomy irrigation is used for patients who have a
descending or sigmoid colostomy because these patients still have majority of the large intestine
in place and is able to produce formed stool when compared with other types of ostomies (hence
these patients will have the most success with ostomy irrigation for bowel training).

Purposes:
1.To empty the colon of feces, gas, mucus, and establish a regular pattern of evacuation
and prevent constipation

2.To clean the intestinal tract in preparation for barium enema, diagnostic procedures or
colostomy closure.

Equipment:
● Moisture resistant bag ● Lubricant
● Colostomy appliance and ● Clean gloves
dressings ● Bath blanket
● Irrigation equipment ● IV pole to suspend the irrigation
● A bag to hold the solutions bag
● Disposable stoma irrigation ● Bed pad
drainage sleeve with belt ● Bed pan

PROCEDURE RATIONALE
1. Determine the purpose of the irrigation
and which stoma is to be irrigated. Stoma location is an indicator of the section of
Usually, the proximal stoma is irrigated, to bowel in
stimulate the bowel to evacuate. However, which it is located and a predictor of the type
the physician may want the distal stoma of fecal drainage to
to be irrigated as well in preparation for expect.
diagnostic procedures. If there are two
stomas, determine which is the distal and
which is the proximal.
 PROCEDURE RATIONALE
2. Before a colostomy irrigation:
a. Assess the client’s readiness to
select and use the equipment. Because ● Ostomy product choices are based on
many types of irrigation sets are the patient’s needs and preference.
available, clients should begin with a ● Auscultation is needed to assess for
starter set until they are familiar with any abnormal abdominal sounds which
the colostomy and the problems of may contraindicate the irrigation.
irrigating it. Later with the help of an ● Abdominal distention may cause
enterostomal therapy nurse or a abdominal cramps during the
qualified person from a surgical supply irrigation.
house, the client can select the set
that is most appropriate.

b. Auscultate the abdomen for bowel

sounds.

c. Palpate the abdomen for distention.

3. Explain the procedure and its purpose.

The total irrigation process usually takes To promote cooperation and to relieve anxiety
about 1 hour. of the patient.

4. Assist the client who is to remain in bed to ● To allow the nurse to do the procedure
without difficulty.
a side-lying position, and place a
● Placing a disposable bed pan on the
disposable bed pad on the bed in front of bed ensures that the waste is properly
disposed.
the client. Place the bedpan on top of the
disposable pad, beneath the stoma. Assist
an ambulatory client to sit on the toilet or
on a commode in the bathroom

5. Ensure that the client’s gown or ● Draping is also part in the provision of
the patient’s privacy.
pajamas are moved out of the way to
● Explaining each steps to the client may
prevent soiling, and drape the person reduce anxiety and may promote
participation instead.
appropriately with the bath blanket to
prevent undue exposure. Throughout the
technique provide explanations, and
encourage the client to participate as
much as the client desires.
 PROCEDURE
6. Hang the solution bag on IV pole so the
bottom of the container is at the level of
the client’s shoulder, or 30-45 cm (12-18
in.) above the stoma.
7. Attach the colon catheter securely to the
tubing.
8. Open the regular clamp, and run fluid
through the tubing to expel all air from it.
Close the clamp until ready for irrigation.
9. Don gloves.
10. Remove the soiled colostomy bag, and
place it in the moisture-resistant bag.
11. Center the irrigation drainage sleeve over
the stoma, and attach it snugly.
12. Direct the lower open end of the drainage
sleeve into the bedpan or between the
client’s legs into the toilet.
13. If ordered, dilate the stoma:
a. Lubricate the tip of the little finger.
b. Gently insert the finger into the
stoma, using a massaging motion.
c. Repeat steps a and b above, using
progressively larger fingers until
maximum dilation is achieved.
14. Lubricate the tip of the stoma cone or
colon catheter.
RATIONALE
This height provides a pressure gradient that
allows fluid to flow into the colon. The rate of
flow can be regulated by the tubing clamp.
To keep the catheter from getting plugged.
Opening the clamp releases air bubbles in the
set-up so that air is not introduced into the
colon which would cause crampy pain.
To avoid contamination and the spread of
microorganisms.
To avoid contamination and control odor.
Attaching the drainage sleeve over the stoma
snugly allow run water into the colostomy.
The irrigation drainage sleeve carries the
irrigation output into the toilet.
● Applying lubricant to the finger before
insertion facilitates easy insertion.
● Gentle insertion prevents irritating the
surrounding mucous membranes.
To facilitate easy insertion of the tube and to
avoid irritating the mucous membranes.
 PROCEDURE RATIONALE
15. Using a rotating motion, insert the ● 3-4 inches tube is ideal for colostomy
catheter or stoma cone through the irrigation; 1 to 2 inches is too short
opening in the top of the irrigation and may spill out the irrigant out of
drainage sleeve and gently through the the stoma. Starting from 6 inches, it
stoma. Insert a catheter only 7cm (3in); would be too long already and may
insert a stoma cone just until it fits snugly. perforate the bowel.
Many practitioners prefer using a cone to ● Using a cone avoids the risk of
avoid the risk of perforating the bowel. If perforating the bowel.
you have difficulty inserting the catheter
or cone, do not apply force.

16. Open the tubing clamp, and allow the fluid Allowing the fluid to flow in slowly avoids
to flow into the bowel. If cramping occurs, painful cramp usually caused by too rapid
stop the flow until the cramps subside and flow.
then resume the flow.

17. After all the fluid is instilled, remove the Most of the water, feces, and flatus will be
catheter or cone and allow the colon to expelled in 10 - 15 minutes.
empty. In some agencies the stoma cone
is left in place for 10-15 minutes before it
is removed. Although not always
indicated, you may ask the client to gently
massage the abdomen and sit quietly for
10-15 min. until initial emptying has
occurred.

18. Clean the base of the irrigation drainage To prevent contamination and the spread of
sleeve, and seal the top and bottom with a microorganisms.
drainage clamp, following the
manufacturer’s instructions.

19. Encourage an ambulatory client to move Ambulating promotes peristalsis and

around for about 30 minutes. completion of irrigation return.
20. Empty the irrigator drainage sleeve, and To prevent leakage and leakage can
remove it. contaminate a wound leading to infection.
 PROCEDURE RATIONALE
21. Clean the area around the stoma, and dry Cleanliness and dryness provides comfort to
it thoroughly. the patient.

22. Put a colostomy appliance on the client as For easy access to the patient.
needed.

23. Promptly report to the nurse in charge any Observing any abnormal changes from time to
problems such as no fluid or stool returns, time prevents further complications.
difficulties inserting the tube, peristomal
skin redness or irritation, and stomal
discoloration.

24. Document all assessments and To promote continuity of care.

interventions. Include the time of the
irrigation, the type and amount of fluid
instilled, the returns, and any problems
experienced.

Learner’s Reflection: (What did you learn Instructor’s Comments:

most of the activity? What is its impact
to you?)