Colostomy stoma care

1. COLOSTOMY CARE
By Manju Mulamoottil Abraham

2. Meaning & Purpose
• Colostomy - A surgical procedure in which the colon is
shortened to remove a damaged part and the cut end
diverted to an opening in the abdominal wall.
• Colostomy care- The pouch, stoma, and skin
surrounding the stoma require care and maintenance.
Purpose:
 To maintain integrity of stoma and peristomal skin.
 To prevent infection.
 To promote general comfort and positive self-image.
 To provide clean ostomy pouch for fecal evacuation.
 To reduce odor from overuse of old pouch.

3. Indication for Colostomy
• Birth defect
• Inflammatory bowel disease
• Injury to the colon or rectum
• Partial or complete intestinal or bowel blockage
• Rectal or colon cancer
• Wounds or fistulas in the perineum

4. Colostomy types

5. Location of Stoma
• The ascending colostomy is located on the right side
of the abdomen.
• The transverse colostomy is in the upper abdomen,
either in the middle or toward the right side of the body
• Descending or sigmoid colostomy is located on the
lower left side of the abdomen.

6. What to expect ?
Ascending
colostomy
Transverse
colostomy
Descending
colostomy
Sigmoid
colostomy
Liquid
Digestive enzyme
Semi solid
Digestive enzyme
Resembles normal
bowel movement
Resembles normal
movement

7. Assessment
• Size:
 Round - measure using stoma measuring guide
 Oval - measure length and width
• Colour:
 Red - adequate blood supply
 Pale - low haemoglobin
 Dark red/purplish tint - indicates bruising
 Grey to black - no blood supply
 Other - Appearance healthy - Shiny & moist

8. Assessment - Peristomal skin
• Colour
 Healthy - no difference from adjacent skin surface
 Erythema - red
 Bruised - purplish to yellowish colour
• Integrity
 Intact - no breakdown in skin
 Macerated - white friable skin, too much moisture
 Erosion - superficial skin damage
 Rash - an outbreak of lesions on the skin
 Ulceration - a wound through the dermis layer
 Other - Turgor normal (soft, good elasticity)
 Flaccid - weak flabby, firm - hard

9. Assessment- Stoma
• Stoma Colour:
 Normal - Pink/red/warm to touch
 Abnormal - black/dusky/pale/sloughy
• Skin:
 Normal - In the post-operative period the stoma can be
quite swollen. It may reduce in size for about 6 weeks
after surgery.
 Abnormal - Any sudden or unexplained swelling of the
stoma
• Bleeding Stoma:
 Normal - A slight smear of blood on the wipe when
washing or drying the stoma.
 Abnormal - Excessive bleeding when cleaning the
stoma/blood in the pouch/bleeding from inside the

10. Pre- procedure preparation
• Detailed history taken down: current complaint, history of
presenting illness, past medical history (co-morbidities),
surgical history, social and environmental history.
• Medications and allergies documented.

11. Procedure
 Measure the stoma if the ostomy is new or use the
previously cut pattern.
 Place pattern on the back of the ostomy bag and draw
the proper size opening. Do not cut more than one bag
for next ostomy change if the stoma is still shrinking.
 Place a finger inside the bag to prevent cutting through
the bag when cutting the hole into the wafer. The wafer
should fit just around the stoma in order to minimize the
amount of skin exposed.

12.  You should not apply the wafer if too much skin is left
exposed to stool drainage. You can always cut the wafer
larger if it is too small at first.
 Empty contents of bag.
 Remove old bag and stoma wafer, by using adhesive
remover or gently pulling bag away from skin and placing
your hand on the skin to decrease pulling on the skin.
 The skin may look dark pink when the bag is first removed.
This fades quickly.

13.  Discard the bag. Put the bag in a small "baggie" before
putting it in the trash.
 Pat the skin around the stoma with gauze soaked in normal
saline.
 Inspect the skin for signs of rash, irritation or breakdown.
 When skin is clean and dry, apply skin prep ( as
prescribed) around the stoma site and let dry until it gets
sticky. Warm the wafer attached to the bag by gently rub it
between your hands to help the wafer mold to the skin.

14.  Touch the skin around the stoma. Reapply the skin prep if
the skin is longer sticky.
 Take the paper off the back of the wafer and place the bag
around the stoma.
 Gently press the bag in place with your hand to help the
wafer mold to skin.
 Smooth out end of bag, fold it two times and put on the
clamp if the bag does not have a Velcro closure.
 If the edges of the wafer are not sticking to the skin:
- Rub skin prep on the edges of wafer.
- Use mesh tape (as prescribed) to tape the edges of
the wafer to the skin.

15. Health education
• Black or dark gray in color (necrotic): this usually
indicates a lack of adequate blood supply to the stoma
and requires immediate intervention.
• Bleeding: the stoma may have suffered trauma or your
child may have internal bleeding.
• Obstructed: blockage of ostomy seen by a small amount
to no stool.

16. Warning Signs & Complications
• Warning signs:
! Bleeding from stoma.
! Bleeding from the skin around the stoma.
! Change in the bowel pattern.
! Change in the stoma size.
! Increased in the temperature
• Complications:
! Leakage.
! Prolapse.
! Obstruction or stenosis.
! Stoma become edematous and enlarged.