Colostomy (ileostomy) care

Ileostomy (colostomy) care

Authors: Brikez Y.I., Poplavets E.V.

Editor: Rednenko V.V.

An intestinal stoma is an opening of the intestine, surgically formed after removal of part of the intestine and directed to the anterior abdominal wall, designed to drain the contents of the intestine. Ileostoma is the name given to an intestinal stoma in which a section of the small (ileum) intestine is removed. The ileostoma is most commonly located in the right ileum. Within a day, the ileostoma produces a large amount of liquid intestinal contents and digestive enzymes that can irritate the surrounding skin. A colostomy is an inference of the large intestine onto the anterior abdominal wall. The location of the inference and the consistency of the discharge will depend on the level of bowel resection. The stoma has no closure, so stoma patients do not feel the urge and cannot control the emptying process, the faeces and gases are expelled spontaneously.

The equipment needed to perform this skill:

• Trainer for ileo-, colostomy care
• Medical devices:
• colostomy bag (one-piece or two-piece draining pack (bag and adhesive plate))
• colostomy bag clip
• anatomical forceps, individually wrapped
• blunt-edged scissors, individually wrapped
• wooden spatula
• Dressings and underwear
• individually wrapped non-sterile gauze wipes: 2 packs of 3.
• Disposable absorbent diaper: 2 pieces.
• Transparent film, thick paper or standard stoma stencil
• Marker
• Skin protection paste
• A container of warm clean water
• Skin antiseptic
• Containers for the collection of medical waste:
• tray
• container "Washing of MI"
• disinfection of MI container
• container "Disinfection of dressing material, PPE".
• container for packages
• bedpan
• Personal protective equipment:
• non-sterile medical gloves (2 pieces),
• a medical mask,
• waterproof apron

Description of the clinical situation: A 76 year old patient. He is in an oncology hospital with bowel obstruction caused by an inoperable tumour of the small (large) bowel. A week ago he underwent a palliative operation with an ileostomy to the anterior abdominal wall. In the postoperative period the ileostoma was opened by the surgeon and a colostomy bag was applied. Carry out colostomy care with replacement and teach the patient how to replace the colostomy bag.

Procedure for performing the skill:

Preparatory phase:

• Perform hygienic hand washing
• Prepare and check the integrity and expiry date of the necessary equipment
• Carry out patient identification
• Say hello to the patient, introduce yourself
• Identify the patient
• Get informed consent for the procedure
• Inform the patient about the impending replacement of the colostomy bag
• Obtain verbal agreement to carry it out
• Prepare the patient:
• Put a diaper on the bed
• Ask the patient to remove any clothing from the area where the colostomy bag is placed
• Ask the patient to sit down on the bed
• Wrap the patient in a second diaper below the stoma
• Wear protective equipment
• Wear an apron, a mask
• Perform hygeinic hand antisepsis
• Wear gloves
• Empty the colostomy bag:
• Open and unwrap the tissue pack on the manipulation table
• Bring the bedpan to the colostomy bag
• Open the lugs of the colostomy bag clamp
• Unwrap the colostomy bag sleeve with drainage opening
• Carefully drain the entire contents of the bag into the vessel
• Take the napkin from the pack
• Wipe the edges of the drainage hole of the colostomy bag with a napkin
• Place the napkin in the "Disinfecting dressing material, PPE" container
• Close the drainage hole:
• Roll up the colostomy bag sleeve with both hands with the drainage opening, wrapping the clamp around the end of the colostomy bag
• Close the lugs of the clamp
• Remove the bedpan
• Pour the contents of the bedpan down the sewage
• Rinse the bedpan with running water
• Disinfect the bedpan chemically
• Remove the colostomy bag:
• ask the patient to lie on their back
• Remove (detach) the sack of the two-piece colostomy bag from the adhesive plate of the colostomy bag:
• hold the adhesive plate of the colostomy bag with your non-dominant hand
• with the dominant hand, detach the sack of colostomy bag from the adhesive plate
• immerse the sack of colostomy bag in the "MI Disinfection" container
• Remove the adhesive plate from the skin (Note: The adhesive plate of the one-piece colostomy bag is removed along with the bag):
• hold the upper edge of the adhesive plate of the colostomy bag with your right hand
• press the skin over the top edge of the adhesive plate of the colostomy bag with your left hand
• gently pull the plate by its retained edge
• remove the adhesive plate from the skin

• fold the adhesive plate of the colostomy bag in half with the adhesive side facing inwards
• place the plate in the "Disinfect MI waste" container
• place the tissue pack in the container for packages
• Examine the stoma area:
• Ensure that there is no swelling, redness or maceration on the skin around the stoma
• Remove gloves and place in "Disinfecting dressing material, PPE" container

Main stage:

• Perform hygeinic hand antisepsis, wear gloves
• Treat the skin around the stoma for the first time
• open and unwrap the second pack of tissues
• open and unwrap the packaging with tweezers
• take tweezers like a writing pen in your dominant hand
• place the tweezers' packaging in the container for packages
• use tweezers to take the cloth from the pack
• take a container of warm water with your non-dominant hand
• moisten a napkin over the tray with warm water
• place a container of warm water on the manipulation table
• wipe the skin without pressure around the stoma with a napkin
• place the napkin in the "Disinfecting dressing material, PPE" container
• Repeat the treatment
• Dry the skin around the stoma
• use tweezers to take the napkin from the package
• dry the skin without pressure with blotting around the stoma with napkin
• place the napkin in the "Disinfection of dressing materials, PPE" container
• place the tweezers in the "Washing of MI" container
• place the tissue pack in the container for packages
• Make sure there is no hair on the stool bag

Prepare a stencil:

• in the absence of a standard stencil:
• Prepare a stencil from a diaper
• take a transparent diaper
• Place the transparent diaper tightly over the stoma
• Draw the outline of the stoma on the diaper with a marker    
• open and unwrap the package with the scissors       
• Take scissors and cut the stoma stencil out of diaper
• put the diaper remnants in the "Disinfection of dressing materials, PPE" container
• place the scissors on the manipulation table on the unfolded pack
• Prepare a paper stencil      
• apply a diaper stencil to the hard paper    
• trace the stencil on the paper with a marker     
• place the diaper stencil in the "Disinfection of dressing material, PPE" container        
• use scissors to cut out a stoma stencil from paper    
• put the remaining paper into the "Disinfection of dressing material, PPE" container        
• place the scissors on the manipulation table on the unfolded pack
• when a standard stencil is available:
• take a standard cardboard stencil (with holes for stomas of different diameters and shapes)
• Place (try on) the opening of the stencil on the stoma (the opening of the stencil should be a few millimetres wider than the stoma)
• match the appropriate stoma diameter on the stencil
• remove the stencil

Prepare the colostomy bag:  

• apply a paper stencil centrally to the protective paper covering of the adhesive layer of the colostomy bag  
• trace the outline of the stencil with a marker
• take scissors and cut a hole in the glue layer on the outline with scissors
• Place the cut piece of adhesive plate in the container "Disinfection of dressing materials, PPE"
• place the scissors in the "Washing of MI"container
• ask the patient to hold the adhesive plate of the colostomy bag tightly between the palms of their hands for 2 minutes

Apply a protective paste to the skin around the stoma

• open the tube of protective paste
• take a spatula
• squeeze a small amount of protective paste from the tube onto a spatula
• Apply a thin layer of protective paste with a spatula no more than 5 mm from the stoma
• leave the paste to dry for 1-2 minutes

Glue on the new colostomy bag (Note: The two-piece colostomy bag is glued on demounted state: first the adhesive plate is glued on, then the colostomy bag is attached):

• make sure there is a clamp on the colostomy bag
• Remove the protective film from the adhesive plate of the colostomy bag without touching the adhesive part of the plate and place the film in the container "Disinfection of dressing materials. PPE"
• ask the patient to inflate their stomach
• place the colostomy bag with the drainage hole towards the patient's feet
• align the bottom edge of the cut-out hole and the stoma
• Place the bottom of the adhesive plate of the colostomy bag on the lower edge of the stoma, exactly along the contour
• glue the rest of the adhesive plate to the skin, working your way up
• Smooth the edges of the glued colostomy bag plate from the centre to the periphery
• pull lightly on the tip of the bag to check that it is securely fastened
• give the stencil of the stoma to the patient
• ask the patient how they are feeling

The final stage:

• remove the diaper from the patient
• place the diaper in the container "Disinfection of dressing materials. PPE"
• remove the diaper from the bed
• place the diaper cloth in the container "Disinfection of dressing materials. PPE"
• remove the apron and treat it by spraying
• remove the gloves with the work surface facing inwards
• Place the gloves in the "Disinfection of dressing materials. PPE"
• remove the mask
• place the mask in the "Disinfection of dressing materials. PPE"
• carry out hygienic hand washing
• record the manipulation in the medical records