The document discusses different types of intestinal ostomies including colostomies. It describes the procedure for colostomy care including necessary supplies, assessment of the stoma, cleaning and changing the pouch and barrier. Guidelines are provided such as checking the stoma regularly, keeping the skin clean and dry, and recording intake and output. Drainable pouches are used when frequent emptying is needed and one-piece or two-piece pouches can be used.

1. DEMONSTRATION
ON
COLOSTOMY CARE
MR. SAM ASIR SUGANTHARAJ.R,
M.SC(N),
DEPT OF MEDICAL SURGICAL
NURSING,
SHNC.

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

3. Types of intestinal ostomies
gastrostomy,
Jejunostomy,
Ileostomy,
Colostomy.

6. Gastrostomy
 It is an opening through the abdominal
wall into the stomach.

7. Jejunostomy
 Opens through the abdominal wall
into the jejunum.

8. ileostomy
 Opening of the abdominal wall into the
ileum.

9. COLOSTOMY
 Opening of the abdominal wall into
the colon

10. PURPOSE OF BOWEL
OSTOMIES To divert the bowel to an opening in the
abdomen
 To drain faecal material,
Bowel diversion ostomies are classified
according to their:
 Status ie: temporary or permanent.
 Anatomic location,
 Construction of stoma.

11. 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.

12. Types of colostomy
TRANSVERSE
A. LOOP
B. DOUBLE BARREL
ASCENDING
DESCENDING
SIGMOID

13. TRANSVERSE COLOSTOMIES
 Transverse colostomies
 The transverse colostomy is in the
 upper abdomen,
 either in the middle or toward the right
side of the body.
 This type of colostomy allows the stool to
leave the body before it reaches the
descending colon.

15. LOOP COLOSTOMY
 The loop colostomy may look like one
very large stoma, but it has 2
openings.
 One opening puts out stool, the other
only puts out mucus. .

17. DOUBLE-BARREL
COLOSTOMY
 In a double-barrel colostomy, the
surgeon divides the bowel completely.
 Each opening is brought to the surface as
a separate stoma.
 The 2 stomas may or may not be
separated by skin.
 one opening puts out stool and the other
puts out only mucus
 (this smaller stoma is called a mucus
fistula).

19. ASCENDING COLOSTOMY
 The ascending colostomy is placed
on the right side of the belly.
 Only a short portion of colon
remains active. This means that the
output is liquid and contains many
digestive enzymes.
 A drainable pouch must be worn at
all times, and the skin must be
protected from the output.

21. Descending and sigmoid
colostomies In the descending colon, the descending
colostomy is placed on the lower left side of the
belly.
 Most often, the output is firm and can be
controlled.
 A sigmoid colostomy is the most common type
of colostomy.
 It’s made in the sigmoid colon, and located just a
few inches lower than a descending colostomy.
 Because there’s more working colon, it may put
out solid stool on a more regular schedule.

23.  Both the descending and the sigmoid
colostomies can have a double-barrel or
single-barrel opening.
 The single-barrel, or end colostomy, is
more common.
 The stool of a descending or sigmoid
colostomy is firmer than the stool of the
transverse colostomy.

26. PERMANENT COLOSTOMY
 Blockage
 Injury
 Colorectal cancer
 Colonic polyps
 Diverticulitis
 Imperforate anus
 Irritable bowel syndrome
 Ulcerative colitis

28. 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.

29. 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
fecal material in pouch.

30. 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.
 Reduces trauma,jerking, irritates skin and can
cause tear.
 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.

31. PROCEDURE
 Observe stoma for
 colour,
 swelling,
 trauma,& healing. Stoma should be moist and pink
 Cover the stoma with a gauze piece to prevent the
fecal 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.

32.  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.
 To prevent irritation to skin.
 Use the pouch if it is drainable using a clamp or
clip
 Remove gloves and wash hands.
 Make the patient comfortable
 Clean the area and replaceall articles.

33. Guidelines
 Keep odour as free of odors 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.

35.  Size of the stoma stablizes 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 out put 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.

36.  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.

41. Drainable pouch
 Drainable pouches
are generally used
when the output
will need to be
drained frequently,
e.g. ileostomies.
 Special drainable
pouches with a tap
outlet are used for
urostomies.

42. One piece pouch
 One-piece
pouches, as the
name suggests,
are all in one piece,
i.e. the whole thing
is removed when
the pouch is
changed.

43. Two-piece pouch
 Two-piece pouches – available for all
types of stoma – have a separate
base plate flange to which a pouch is
fitted.
 The base plate flange is left in place
on the abdomen, with a new pouch
fitted when necessary. Every 2-4 days
the base plate flange will need to be
changed too.

44. DOCUMENTATION
 Record the
procedure with
following details
(with date & time ).
 Amount,
 colour,
 and consistency of
the fecal matter in
the pouch.