2. introduction
The word ‘stoma’ refers to an
‘artificial opening’. When surgery
is required to remove part of the
bowel or bladder as a result of
disease or trauma, a stoma is
formed on the surface of the
abdomen to allow excretion of
faecal matter or urine. A
‘colostomy’ is an artificial
opening of the colon onto the
abdominal surface. It may originate
from:
3. CONT
● the sigmoid colon
● the descending colon
● the transverse colon
● the ascending colon.
4. cont
A colostomy is usually sited at
the left iliac fossa. If the
colostomy exits from the sigmoid
or descending colon, its output
will be formed with anormal
faecal odour.
If it is sited in the transverse or
ascending colon,
the output will be loose and
copious with a strong odour.
5. cont
An ‘ileostomy’ is an artificial
opening of the ileum onto the
abdominal surface. It is usually
sited in the right iliac fossa.
The output from an ileostomy
(‘effluent’) is very soft and fluid,
which necessitates emptying of the
appliance approximately six times
per day.
6. Characteristics of
Stomas
Normal stomal characteristics:
pink-red, moist, bleeds slightly when
rubbed, no feeling to touch, stool
functions involuntary, and
postoperative swelling gradually
decreases over several months.
6
9. Preoperative Management
and Nursing Care
1. Prepare the patient for general abdominal
surgery
2. Administer replacement fluid, as ordered,
before surgery due to possible increased output
during the postoperative phase.
3. Provide low-residue diet before NPO status.
4. Explain that the abdomen may be marked by
the ostomy specialty nurse or surgeon to ensure
proper positioning of the stoma.
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5. Other considerations when selecting a
stoma include:
a. Positioning within rectus muscle.
b. Avoidance of bony prominences.
c. Clearance from umbilicus, scars, and deep
creases,
observed in lying, sitting, and standing
positions.
d. Positioning on a flat pouching surface.
e. Avoidance of beltline when possible.
f. Positioning within patient’s visibility to
optimize
11. Postoperative Management
and Nursing Care
1. Administer general abdominal
surgery care .
2. Assess stoma every shift for
color and record findings:
a. Normal color: pink-red
b. Dusky: dark red; purplish hue
(ischemic sign)
c. Necrotic: brown or black; may be
dry (notify health care provider to
determine extent of necrosis)
13. cont
3. Apply pouching system as close
to stoma as possible without it
being rubbed.
4. Check for abdominal distention,
which reduces blood flow to stoma
through mesenteric tension.
5. Evaluate and empty drains and
ostomy pouch frequently to
promote patency and maintain seal.
14. cont
6. Monitor intake and output with
extreme accuracy, because output
may remain high during early
postoperative period.
7. Suction and irrigate NG tube
frequently, as ordered, to relieve
pressure and decrease gastric
contents.
8. Offer continued support to
patient and family.
15. Complications
1. Mucocutaneous separation (between
skin and stoma)
2. Stomal ischemia
3. Stomal stricture or stenosis (usually a
long-term complication)
4. Stomal prolapse
5. Peristomal hernia
6. Peristomal skin breakdown from
exposure to fecal output, allergic reaction
to products, or infection, such as
candidiasis
16. Information about
appliances
In the initial post-operative period, a clear
plastic appliance (stoma pouch) is used to
allow observation of output. However,
opaque appliances may be used later.
Colostomy bags are available with flatus
filters and charcoal filters to decrease
odour.
A patient with an ileostomy will need to
use a drainable device, where the end is
sealed with a tie or plastic clip. These are
also available with filters.
18. changing a stoma bag
Equipment
● Warm water in sink.
● Soft wipes/gauze (not tissue or
toilet paper as this disintegrates
when wet).
● New appliance.
● Scissors.
● Template.
19. ● Clip or tie fixed on bottom of
pouch if required.
● Plastic disposal bag.
● Protective sheet/tissue paper.
● Pen.
● Barrier cream if advised.
● Gloves and apron if nurse
assists.
20. Procedure
● Prepare equipment.
● Protect clothing.
● If patient is wearing a drainable
pouch he should empty it first to
avoid spillage.
● Remove soiled pouch by starting
at the top of the flange and gently
peeling from top to bottom. Use the
free hand to support
surrounding skin.
21. ● Wash around stoma and
surrounding skin using soft wipes.
Place these in rubbish bag.
● Thoroughly dry skin with soft
wipes. Dispose of wipes.
● Check the condition of the
stoma and surrounding skin and
apply barrier cream if advised.
22. ● If necessary, measure the size of the
stoma and make a template. Using the
template cut the flange to the correct
size. The flange should fit snugly around
the stoma. If it is too small, the edge of
the flange may cause bruising or
bleeding due to friction with the stoma.
If it is too big, excrement may spill onto
the surrounding skin causing soreness
and, potentially, skin breakdown.
24. ● Remove backing paper from the
new stoma bag. Fold the bag in half
so that the flange is rounded.
Position the bag onto the stoma
by matching lower edge of opening
with bottom edge of stoma.Fold top
half of the flange over stoma and
press firmly on the skin.
Ensure that the stoma mucosa is
not covered with the flange.
25. ● Apply gentle pressure around the flange
ensuring that it adheres to the skin. Check
that it is free of creases as these may
cause leakage.
● Empty soiled pouch into toilet and
discard into rubbish bag.
● Wash hands.
● Document how patient coped with the
procedure and that the stoma bag has been
changed. Any problems should be reported
to a senior colleague.
