12.17: Ostomy Care

Introduction

An ostomy is a surgical procedure that creates an artificial opening from the intestines to the outside of the body, allowing for the rerouting of effluent. This opening is known as a stoma. A stoma usually protrudes above the skin surface, appearing pink or red, moist, and round, and it lacks nerve sensations.

There are different types of ostomies, including colostomies, ileostomies, and urostomies:

1. A colostomy involves bringing a part or section of the colon, or large intestine, to the abdominal surface to create a stoma, typically on the left side of the abdomen. Colostomies are often necessary when part of the colon is removed or needs to be bypassed due to conditions such as colorectal cancer, diverticulitis, or injury. Waste from the colon is collected in a colostomy bag attached to the stoma. Depending on the medical condition, colostomies can be temporary or permanent.
2. Ileostomy involves bringing out the terminal part of the small intestine, known as the ileum, through the abdominal wall. Ileostomies are performed when the entire colon must be bypassed or removed. Waste is collected in a unique bag, similar to a colostomy. This type of ostomy is often temporary but may also be permanent and is commonly required for conditions like Crohn's disease or ulcerative colitis.
3. Urostomy is another type of ostomy where urine is diverted through an opening in the abdomen. It is typically performed when the bladder is removed or bypassed due to conditions like bladder cancer.

Ostomy Care Steps

1. Preparation and Hygiene: Begin with thorough handwashing to prevent infection. Wear disposable gloves for hygienic handling of stoma and supplies.
2. Gathering Supplies: Collect necessary items, including a new ostomy pouch, skin barrier/wafer, scissors (for resizing the barrier if needed), stoma measuring guide, clean washcloths or wipes, warm water (use soaps or creams only if recommended), and a disposal bag for the used pouch.
3. Removing the Old Pouch: Gently peel the old pouch from the skin to avoid skin irritation and dispose of it properly.
4. Cleaning the Stoma and Skin: Inspect the stoma and surrounding skin for inflammation, necrosis, persistent bleeding, discharge, pus, or other abnormal changes. Promptly consult a healthcare provider if any irregularities are observed. Clean the skin around the stoma with warm water, using a soft cloth or wipe, and pat dry.
5. Measuring and Preparing the Skin Barrier: Resize the skin barrier using a stoma measuring guide. Cut it to fit closely around the stoma without touching it.
6. Applying the New Pouch: Place the skin barrier around the stoma, ensuring a snug fit. Attach the pouch securely, following the manufacturer's instructions.
7. Disposing of Used Materials and Hand Hygiene: Properly dispose of all used materials. Remove gloves and wash hands thoroughly.
8. Documentation and Communication: Record the procedure in the patient's medical record, noting the stoma and skin condition. Report any abnormalities to a healthcare professional.

The change frequency of the ostomy pouch varies based on pouch type and individual needs. Providing emotional support and education to patients and caregivers on ostomy care is also vital. Educating them about signs of complications, such as changes in the stoma's appearance, unusual odors, or skin irritation around the stoma, is essential.