Clinical teaching

on colostomy
care

COLOSTOMY CARE
OSTOMY
An ostomy is the surgery to create an opening between an internal organ and the body
surface.

Types of intestinal ostomies

  Gastrostomy
 Jejunostomy
 Ileostomy
 Colostomy

COLOSTOMY
Colostomy is a surgical procedure that brings one end of the large intestine out
through an opening (stoma) made in the abdominal wall. Stools moving through the intestine
drain through the stoma into a bag attached to the abdomen.

Indications
The conditions that can require a colostomy include certain illnesses, injuries, or other
problems with your digestive tract, including:
 Crohn’s disease
 diverticulitis
 an injury to the colon or rectum
 intestinal obstruction, which is a blockage in the large bowel
 colon cancer
 Hirschsprung’s disease, a rare condition that mostly affects children, and can cause
stools to become stuck in the bowels

Types of colostomies
A colostomy can be located in
Ascending,
Transverse,
Descending or
Sigmoid colon.
IT CAN BE TEMPORARY OR PERMANENT,
 Temporary
 It allows the bowel to rest and later may be reanastomosed
 Can be used to treat inoperable bowel cancer, with the ostomy placed proximal to the
cancer
 Most commonly made at the midpoint of the transverse colon
 Permanent
 Usually placed in sigmoid colon
 Easier to manage nearer the sigmoid colon because the stool is more formed here
than in the transverse colon

IT CAN BE SINGLE, DOUBLE BARELLED AND LOOP

 Single barrelled colostomy
Also called An End colostomy. When only one loop end of bowel is opened
onto the abdominal surface. The client has only one stoma. Single barrelled
colostomies are usually permanent.

 Double barrelled colostomy

Is one which both loops i.e., distal and proximal are open onto the abdominal
wall. Are usually temporary. A double-barrelled colostomy can be two separate
stomas. stomas may be adjacent or several inches apart. One for faecal matters and
the other for mucous.
  Loop colostomy
Loop colostomies are temporary and are formed by bringing a loop of colon
through the abdominal wall and supporting it with a plastic brace. A loop with one
stoma and two openings, one stoma expels mucous and is covered with a gauze
dressing or pouch.

Risk of colostomy
A colostomy is a major surgery. As with any surgery, there are risks of allergic
reactions to anesthesia and excessive bleeding.
A colostomy also carries other risks, such as:
 damage to nearby organs
 scar tissue forming in the abdomen, which can cause blockages
 parastomal hernia, which is when your intestines bulge out through the muscles
around the stoma. This can cause a bump in the skin.
 stoma blockage, which is when a build-up of food can block the opening and cause
issues, including nausea, swelling, and output issues
 stoma fistula — a small hole that can develop next to the stoma
 stoma retraction, when the stoma may sinks back beneath the skin and cause leakage
around the colostomy pouch
 stoma prolapse
 stomal ischaemia, when blood supply to the stoma is restricted. This may require
additional surgery.
 Peritonitis
 Stomal necrosis and stenosis

Colostomy Bag
 A colostomy bag is a plastic bag that collects fecal matter from the digestive tract
through a colostomy stoma. Doctors attach a bag to the stoma following a colostomy
operation.
Following a colostomy, a person will have some choice about what type of bag they
want to use. People often refer to each option as a pouching system. Pouching systems come
in a variety of different styles and sizes.
Useful things to look for when picking a pouching system include:
 odor resistance
 a bag that is easy to put on and take off
 a leakproof seal that lasts for up to 3 days
 a bag that is hard or impossible to see under clothes
 a bag that is gentle on skin around the stoma
A pouching system consists of
 A flange, wafer, or skin barrier that attaches to the skin around the stoma.
 A pouch that attaches to the flange and collects the stool as it passes through the
stoma.
Pouching systems come in two basic types:
 A one-piece system where the bag attaches directly to the skin around the stoma.
 A two-piece system where the flange attaches to the skin around the stoma and the bag
attaches to the flange.

COLOSTOMY CARE
Articles required for colostomy care
A clean tray containing
 Mackintosh with draw sheet,
 Kidney tray / paper bag,
 Pair of clean gloves,
 Colostomy bag,
 Normal saline / basin with warm tap water,
 Gauze pieces,
 Gauze pad / tissue paper,
 Skin barrier,
 Stoma measuring guide,
 Pen or pencil and scissors
 Bed pan.
Assessment
1. Identify the type & location of ostomy in the patient.
2. Assess the skin integrity around the stoma and appearance.
3. Note the amount and character of faecal material in pouch.

Procedure
 Arrange the all-necessary articles.
 Explain the procedure to the patient.
 Provide privacy and assist patient to a comfortable position.
 Wash hands & wear gloves to prevent infection.
 Spread Mackintosh & draw sheet to protect linen
 Remove used pouch & skin barrier gently by pushing the skin away from the barrier.
 Remove clamp and empty the contents into the bed pan.
 Rinse the pouch with tepid water or normal saline to minimize the odour & growth of
microbes
 Discard the disposable pouch in paper bag.
 Observe stoma for Colour, swelling, trauma, & healing.
 Stoma should be moist and pink
 Cover the stoma with a gauze piece to prevent the faecal matters from contacting with
skin
 Clean stomal region gently with warm tap water using gauze pad.
 Do not scrub the skin, dry completely by patting the skin with gauze.
 Remove gauze and clean stoma with gauze and pat dry
 Measure the stoma using measuring guide.
 Ensures accuracy in determining correct pouch size needed
 Trace same circle behind the skin barrier, using scissors, cut an opening 1/16th to
1/8th inch larger than stoma before removing the wrapper over adhesive part.
 Put skin barrier and pouch over the stoma, and gently press on to the skin, for 1-2
minutes.
 Remove gloves and wash hands.
 Make the patient comfortable
 Clean the area and replace all articles.

What is life like with a colostomy bag?

A person with a colostomy bag will be able to continue with many of the same
activities that they did before their surgery. Most other people will be unaware that someone
uses a colostomy bag unless that person tells them.
 People with a colostomy bag will need to avoid lifting heavy items and may need to
visit the bathroom more frequently to manage their pouching system. Otherwise, a
colostomy bag should not impact too much on someone’s daily routine.

If a pouch is in position securely, an individual with a colostomy bag should be able to

take part in most sports and physical activities, including running and swimming. Although
people should be careful if taking part in contact sports, they may wish to wear a belt or
guard for protection.

Some things a person has to consider when living with a colostomy bag include the
following:
 Carrying extra bags and spare supplies when traveling.
 Taking care when using a seat belt, so it does not lie across the stoma.
 Thinking about maybe avoiding foods that cause flatulence.
 Taking extra care with children and pets to avoid damaging the bag.
 Leaving the bag in place or removing it when showering and covering the stoma if
removing.
 Looking for high waisted clothes and underwear or considering buying specialty
clothes.
 Having a colostomy bag should not affect a person’s sexual activity or pregnancy.

Guidelines
 Keep odour as free as possible.
 Ostomy bag should be emptied frequently.
 Check the stoma regularly, the colour should be dark pink to red and moist.
 Pale colour indicates anaemia,
 Dark or purple blue indicates compromised circulation.
 Size of the stoma stabilizes 6-8 weeks.
 If dressing, check frequently for drainage and bleeding.
 Keep the skin around the stoma (peristomal area) site clean and dry.
 If not, it causes skin irritation and infection.
 Intake and output chart must be recorded for every 4 hours.
 Encourage the patient to participate in care and to look at the ostomy.
 Can help the patient by listening, explaining, being available and supportive.
 Encourage the patient to avoid fibre rich diets.
 Encourage the patient to drink fluids.
 Educate the patient about the various methods of odor control measures.
 Chlorophyll rich diet will deodorise the feces
 Direct contact sports and heavy lifting must be avoided.
Bibliography
 Joyce M Black, Hawks. Medical Surgical Nursing, clinical management for positive
outcomes. 8th edition(vol 1). Elsevier India. 2009.
 GG Reddemma. Advance concept of nursing practice. 1st edition. India.Jaypee medical
publishers. 2021.
 Lewis, Dierksen, Heitkempter, Bucher and Camera. Medical Surgical Nursing,
assessment and management of clinical problems. 8 th edition. Elsevier Mosby
publication. Philadelphia.
 https://www.medicalnewstoday.com/articles/326353#what-is-life-like-with-a-
colostomy-bag