Categories
204 RLE Procedures

COLOSTOMY CARE

Definition

Maintaining an optimum hygienic of a surgically created opening between colon and abdominal wall that allows fecal elimination.

Purposes

  • To allow fecal elimination
  • To prevent infection on operative site
  • To facilitate accommodation of excretion and avoid spillage of contents
  • To collect effluent for assessment of the amount and type of output
  • To minimize odors for the client’s comfort and self-esteem

Principles

  • Obtain doctor’s order
  • Explain the procedure to the patient
  • Provide privacy
  • Use universally precautions in handling body secretions
  • Uphold aseptic technique

Equipment

  • Large tail closure                                     Irrigator bag or enema bag
  • Water soluble lubricant                        Cone tip or soft rubber catheter
  • Cleansing agent                                         no. 22 or no. 24 with shield
  • Clean gloves
  • Skin protectant
  • Irrigation sleeve

1. Check doctor’s order and explain procedure to the patient.

Rationale: Relieve anxiety and promote compliance

2. Select a consistent time of the day that best fit patient lifestyle to irrigate free from distraction.

Rationale: Establish regularity.

3. Have patient sit on a chair or commode. Provide privacy.

Rationale: To be in comfortable position.

4. Hang the irrigating reservoir with prescribed solution so bottom of reservoir is at the level of patients shoulder and above the stoma.

Rationale: Height regulates pressure of irrigant.

5. Wear gloves and mask

Rationale: Prevent transmission of microorganism and inhalation of fecal odor.

6. Remove pouch or covering of stoma and apply irregular sleeve, directing the open tail into the commode.

Rationale: Allows water and feces to flow directly into the commode.

7. Open tubing clamp or irrigating reservoir to release a small amount of solution into the commode.

Rationale: Removes air from the set-up; prevent air to enter into the colon and cause cramping again.

8. Lubricate the tip of the cone/catheter, insert about 3 inches into the stoma. Hold cone/shield gently but firmly  to prevent back-flow of water.

Rationale: Prevent intestinal perforation and irritation of mucus membrane.

9. Allow water to enter  colon slowly over 5-10 minutes period. If cramping occurs, slow the flow rate or clamp tubing to allow cramping to subside.

Rationale: Slow relaxes bowel to facilitate passage of catheter.

10. Hold cone for 10 sec. after water is instilled, then gently remove cone from stoma.

Rationale: Cramping occur if too rapid flow, cold water excess solution on a colon ready to function.

11. As feces and water flow down sleeve, periodically rinse sleeve with water. Allow 10-15 min  for most of the return, then dry sleeve tail and apply tail closure.

Rationale: To cleanse the sleeve for patency.

12. Leave sleeve in place for approximately 20 more minutes while patient gets up and moves around.

Rationale: For patient’s comfort.

13. When returns are complete, clean stoma area with mild soap and water, pat dry, reapply pouch.

Rationale: To cleanse the stoma and make the pouch available for use.

14. Leave patient dry and comfortable.

Rationale: For patient comfort.

15. Do aftercare of equipment with soap and water, dry and store in well-ventilated area.

Rationale: To be ready for the next use.

16. Chart procedure done, reaction of patient.

Rationale: For documentation purposes.

Reference:

Kozier, Barbara, et.al. Fundamentals of Nursing Philippines: Pearson Education South Asia PTE LTD.2004. pp. 1247-1250