You are on page 1of 17

Pre-operative

Siting For stoma

Surgery
SYAIFUL SYARIFUDDIN
Ns. CWCC. CCT. M.Kep

OUTLINE

Backgroung (BILL OF RIGHT/10 Hak Ostomate


STOMA SITE SELECTION PRINCIPLES
Position
Cunstructed Ostomy Criteria
CASE STUDY ASSESMENT
Procedure
Key Points to Consider
Reference

BILL OF RIGHT/10 Hak Ostomate

(Issued by the IOA Coordination Committee June 1993,


revised June 1997
INDONESIAN OSTOMY ASSOCIATION translate, since 2000 )

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Get Counseling before surgery


The best position of Stoma
Good Shape
Get Stoma Care after surgery
Emotional Support from Professionals
Get Health Education
Product Information
Organizations Support
Follow Up and Check Up for the Rest of life
Get Insurance and Privacy

STOMA SITE SELECTION PRINCIPLES

The stoma should


be well supported
by the rectus
muscle to
reduce any
potential problems
of parastomal
hernia in the
future.

POSITION

With the patient in sitting standing bending and lying positions,


identify any potential problem areas. It is important to assess the abdomen in
different positions since the contours may change.

Inserted Into a
Muscle (Rectus)

On a Flat
Surface, on
Healthy Skin

Moved A Way
From Scars

Cunstructed
Ostomy
Criteria1

Visible by the
patient

Moved Away
From Bone Edges

According to an
Assesment made
in different
Anatomical
position
1

WCET International Ostomy Guideline June 2014

CASE STUDY ASSESMENT


Mr. TSK
Age : 85 Years
His wife was also Diagnosed with
cancer. Patient admitted to UMMC
Via
Trauma
and
emergency
Departement on 20 Oktober 2015
Patient conplaint of Per-Rectal
bleeding for 4 Month. On and Off
Increase Bleeding with Sticking
mucus discharge mixed with stool.

Rectal Adenocarcinoma

TOOLS

APRON

ALCOHOL
SWAB

Transparant film

MARKER

CUTTING

Procedure
Examine patients
exposed abdomen in
various positions
(standing, lying,

sitting and
bending
forward) to
observe for creases,
valleys, scars, folds,
skin turgor and
contour.

Procedure

Draw an imaginary line where


the surgical incision is going
to be. Choose a point
approximately 2 inches from
the surgical incision where 2
3 inches of flat adhesive barrier
can be placed.
With patient lying on back
identify the rectus muscle.
(This can be done having the
patient do a modified sit up
(raise the head up off the
bed). Placement within the
rectus muscle can help to
prevent peristomal hernia
formation and/or prolapse.
See picture below to identify
desirable surface areas to
mark.

Procedure

Choose an area that is visible to


the patient, and if possible
below the belt line to conceal
the pouch.
If the abdomen is large, choose
the apex of the mound or if the
patient is extremely obese,
place in the upper abdominal
quadrants.
It may be desirable to mark sites
on the right and left sides of the
abdomen to prepare for a
change in the surgical outcome
(you may want to number your
first choice as 1 #).

Procedure

Clean the desired site with alcohol and allow


to dry. Then proceed with marking the
selected site with a surgical marker / pen.
You may cover with transparent film
dressing if desired to preserve the mark.

Procedure
Once marked have
the patient
assume sitting,
bending and lying
position to assess
and confirm best
choice. It is
important to have
the patient confirm
they can see the
site.

Key Points to Consider


Positioning issues: contractures, posture, mobility e.g.
wheelchair confinement, use of walker etc.
Physical considerations: large/protruding/pendulous
abdomen, abdominal folds, wrinkles, scars/suture lines,
other stomas, rectus muscle, waist line, iliac crest, braces,
pendulous breasts, vision, dexterity, presence of hernia.
Patient considerations : Diagnosis, history of
radiation, age, occupation

Other: Surgeon preferences, patient preferences, type of


ostomy or diversion, anticipated stool consistency.

Multiple stoma sites: Mark fecal and urinary stomas


on different horizontal planes/lines.

Reference

ASCRS. Principles of Stoma Marking ( 2004)

WCET. (2014). WCET International Ostomy Guideline. WCET


Journal June 2014.

IOA, (2004) Coordination Committee June 1993, revised June


1997

THANK YOU
MERAWAT DENGAN CINTA