Maintaining an optimum hygienic of a surgically created opening between colon and abdominal wall that allows fecal elimination.
- 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
- Obtain doctor’s order
- Explain the procedure to the patient
- Provide privacy
- Use universally precautions in handling body secretions
- Uphold aseptic technique
- 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.
Kozier, Barbara, et.al. Fundamentals of Nursing Philippines: Pearson Education South Asia PTE LTD.2004. pp. 1247-1250