COLOSTOMY IRRIGATION is a way to Performance Phase 10.

Apply gloves, lubricate cone tip,

regulate bowel movements by emptying reach through top of irrigation sleeve,
the colon at a scheduled time. The 4. Position client. and hold cone tip snugly against stoma
process involves infusing water into the opening. Start inflow of solution.
colon through the stoma. This • a.On toilet or in chair in front of toilet, Adjust direction of cone to facilitate
stimulates the colon to empty. By if ambulatory. inflow of solution.
repeating this process regularly once a • b.On side, with head slightly elevated,
day or once every second day the colon if unable to be out of bed. • Prevents trauma to stoma; cone tip
can be trained to empty with no spillage avoids perforation of bowel. Cone aids
of waste in between irrigation. 5. Wash hands and apply disposable in retaining solution during inflow.
gloves.
• Irrigation should be done at the same 11. Allow solution to flow in over 5-to-
time each day to establish regularity of • to prevent transmission of 10-minute period.
bowel evacuation. microorganisms and protect self • Allow some of the solution to flow
through the tubing and catheter/cone.
1. KNOWLEDGE Flow in over a 5 - 10-minute period.
6. For adult clients, fill irrigation bag • If cramping occurs, stop the flow for a
1. State the purpose of Colostomy with 500 to 1000 ml warm irrigation few seconds but leave the cone in place.
Irrigation. solution, clear tubing of air. When the desired amount of solution
flows in, or when you feel full, clamp the
• To empty and cleanses the colon and • For cleansing and flushing tubing, and remove the irrigation cone
rectum • to remove cellular debris and surface from your stoma.
• To stimulate peristalsis and help pathogens contained in wound exudates
develop regular bowel movement. or residue from topically applied wound 12. After instilling solution, clamp
• To relieve flatulence. care products. tubing, and remove cone. Discard
• Allows solution to slowly enter colon gloves. Close top of irrigation sleeve.
2. Enumerate the considerations in and avoids cramping. Cold irrigation • Clamp the tubing if cramping occurs,
caring for a client with Colostomy. solution could trigger syncope and until it subsides
bowel cramping. Hot solution could • Once the desired amount of solution is
• This type of surgery--often temporary- damage stoma and intestinal mucosa. instilled, the cone is removed, and feces
-is typically performed for diverticulitis, Air entering the colon may trigger is allowed to drain through the sleeve
inflammatory bowel disease, cancer, cramping. into the toilet.
blockage, injury or a birth defect. • Close top of irrigation sleeve to
7. Hang irrigation container on a hook prevent water and stool from splashing
• The stoma and parastomal area should so that end of bag is np higher than outside the irrigation sleeve.
be gently cleaned with water, dabbed client's shoulder height when sitting or • Close top of irrigation sleeve for
rather than scrubbed, without using 18 to 20 inches above stoma. returns (water and stool) may start
soap. The stoma should be assessed and coming out of your stoma within 5 to 10
must be moist, above skin level, and • The bottom of the bag should be at minutes
pink to red in color, and the peristomal the level of the patient's shoulder. It is
skin should be normal mainly done to prevent the rapid flow of 13. Allow 15 to 20 minutes for initial
fluid. The bottom of the bag should be evacuation; apply gloves. Dry tip of
3. Assemble, equipment, provide placed at least 18-20 inches above the irrigation sleeve and close bottom. Fold
privacy. stomach. sleeves up and over top, leave in place
for 30 to 45 minutes. Discard gloves.
• To conserve time and energy 8. Remove used pouch gently, dispose Client may walk around.
• To reduce embarrassment and anxiety of properly, remove gloves and wash • Fold sleeve up and over top to
of px hands. maintain a closed system for any
remaining stool and irrigation to empty
Equipment: • to prevent transmission of infectious into.
material. • Encourage patient to ambulate to
1.Ostomy irrigation set that consists of • prevents skin irritation facilitate emptying of remaining
an irrigation solution bag and tubing • Encourage patient to ambulate to
with a fluid control clamp and cone tip. 9. Apply irrigation sleeve over stoma, facilitate emptying of remaining stool
2. Water-soluble lubricant tip of sleeve should rest in water in from colon.
3. Ostomy pouch and skin barrier or toilet or in bedpan.
stoma cap cover 14. Apply gloves, unclamp sleeve,
4. Clean disposable gloves • Directs flow of stool into toilet or empty any fecal contents, remove
5. Toilet facilities bedpan; if in toilet, also controls odor sleeve. Rinse with liquid cleanser and
6. Irrigation sleeve and splashing. cool water. Hand sleeve to dry.
• Since intestinal contents may irritate
the surrounding skin, the patient's paste or powder, wet cloth, non-sterile privacy
stoma should be washed with gloves, and additional cloths.
warm/cool water. 8. Wash hands and apply disposable
• Soap will not irritate it, but soap may 11. SKILLS gloves.
interfere with the skin barrier sticking to • prevents contamination of hands,
the skin. It’s best to only use water Preparatory Phase reduce risk for infection
while cleaning the skin around your
1. Auscultate for bowel sound. 9. Place towel under client.
stoma.
• Documents presence of peristalsis. • Protects bed linens
• Aggressive cleaning can cause
Absence of sounds indicates a problem.
bleeding.
10. remove the used pouch and skin
2. Observe existing skin barrier and barrier gently by pushing skin away
15. Apply new colostomy pouch or pouch for leakage and length of time from barrier. An adhesive remover may
stoma cap covering. in place. be used to facilitate removal of skin
• Change the pouch regularly to avoid • The pouch should be changed every 3 barrier
leakage and skin irritation. to 7 days, not daily. To minimize skin • reduce skin trauma
irritation, avoid unnecessary changing of • Improper removal of barrier will
16. Remove gloves and wash hands. the entire pouching system, but if the irritate patient's skin, cause skin tears,
• to prevent transmission of infectious effluent is leaking under the wafer, and result in poor adhering of the new
material. change it, because skin damage from the pouch.
• prevents skin irritation effluent will cause more skin trauma
than will be caused by early removal of 11. Cleanse peristomal skin gently
COLOSTOMY CARE the wafer. with warm water using gauze pads or
• Determines likelihood of pouch clean washcloth; don't scrub skin; dry
1. KNOWLEDGE loosening from stoma and failing to completely by patting skin with gauze
collect effluent. Routine observation or towel.
1. State the purpose of Colostomy allows for early detection of potential • Avoid use of soap because it leaves a
Care. problems (Turnbull, 2007). Leaking residue on skin that interferes with
• The purpose of colostomy care is for indicates the need for a different pouch pouch adhesion. Skin needs to be dry as
skin protection and care for patient or sealant. skin barrier; pouch does not adhere to
acceptance and to prevent stoma related wet skin, and moisture increases
complications. 3. Observe stoma for color, swelling, patient's risk for fungal infections. If
trauma, and healing blood appears on gauze pad, do not be
2. Enumerate the considerations in • Immediately after surgery, a stoma is alarmed. If rubbed, stomach oozes some
caring for a client with Colostomy. swollen, but it will shrink in size over blood as a result of cleaning process.
• This type of surgery--often temporary-- several weeks. A healthy, healed stoma Stoma's surface is a highly vascular
is typically performed for diverticulitis, appears moist and dark red or pink in mucous membrane. Bleeding into pouch
inflammatory bowel disease, cancer, color. Stomas that are swollen; dry; have is abnormal (Pontieri-Lewis, 2006).
blockage, injury or a birth defect. malodorous discharge; or are bluish,
• Use the right size pouch and skin purple, black, or pale should be reported 12. Measure stoma for correct size of
barrier opening. An opening that's too to the provider. pouch, using manufacturer's
small can cut or injure the stoma and measuring guide.
may cause it to swell. If the opening is 4. Observe effluent from stoma and • provides for accurate fit of pouch
too large, output could get to and irritate record of intake and output. • Ensures accuracy in determining
the skin. In both cases, change the pouch • Plan on routine changing of skin correct pouch size needed. Stoma
or skin barrier and replace it with one barrier pouch at times of less effluent shrinks and does not reach usual size for
that fits well. output. Generally, avoid changing after 6 to 8 weeks.
• The stoma and parastomal area should meals, when gastrocolic reflux increases
be gently cleaned with water, dabbed chance of fecal effluent output. 13. Prepare pouch, remove backing
rather than scrubbed, without using soap. from barrier and adhesive. With
The stoma should be assessed and must 5. Explain procedure to client. leostomy, apply thin circle barrier
be moist, above skin level, and pink to • to reduce anxiety, gain trust and paste around opening in pouch; allow
red in color, and the peristomal skin cooperation to dry
should be normal • prevents skin irritation of uncovered
6. Assemble equipment. peritoneal skin
3. Explain the rationale of each • Organization saves time, optimizes use • Paste facilitates seal and protects skin.
suggested action. of time, and conserves the patient's Stool is alkaline and contains enzymes,
• every action is guided by evidenced energy. and this irritates skin; fecal bacteria
based practice colonize on skin and increase risk for
7. Position client either standing or infection.
4. Enumerate the materials used. supine and drape.
• Supplies include flange, ostomy bag • When patient is supine, there are fewer 14. Apply skin barrier and pouch,
and clip, scissors, stoma measuring skin wrinkles, which allows for ease of increase next to stone occur, use
guide, waterproof pad, pencil, adhesive application of pouching system; barrier paste to fill in; let dry 1 to 2
remover for skin, skin prep, cohesive maintains patient's dignity. Provides minutes.
• Paste creates flat surface for pouch • Record amount and appearance of stool
application. or drainage in pouch, size of stoma,
color of stool, texture, condition of
peristomal skin, and sutures.
14.1 Use skin sealant wipes on skin • Document abdominal distention and
directly under adhesive skin barrier excessive tenderness.
or pouch, allow to dry. Press adhesive • Document nature and location of bowel
of pouch smoothly against skin, sounds.
starting from bottom and working up • Record patient's level of participation
and around sides. and need for teaching.
• Ensures smooth, wrinkle-free seal. Be • Report any of the following to nurse in
aware of any irritated or open areas charge and/or health care provider:
because the skin sealant wipes often • Abnormal appearance of stoma, suture
contain alcohol (Pontieri-Lewis, 2006). line, peristomal skin, character of output,
absence of bowel sounds
14.2 Hold pouch by barrier, center • No flatus in 24 to 36 hours and no stool
over stoma, and press down gently on by third day
barrier, bottom of pouch should point
toward client's knees.
• A different positioning of the pouch is
sometimes necessary to allow better
gravity flow. For example, a patient
confined to bed needs to have pouch
positioned horizontally over the side of
the abdomen.

14.3 Maintain gentle pressure around

barrier for 1 to 2 minutes
• Gentle pressure and body heat assist in
adhesion.

15. Apply nonallergenic paper tape

around skin. barrier in a picture
frame method.
• adds to security of keeping pouch
system attached securely

16. Fold bottom of drainable open-

ended pouches up once and close
using closure device such as clamp.
• Maintains secure seal to prevent
leaking.

17. Properly dispose of old pouch and

sold equipment.
• Lessens odors in rooms

18. Remove gloves and wash hands.

• Reduce transmission of
microorganisms

19. Change pouch every 3 to 7 days

unless leaking.
• Avoids unnecessary trauma to skin
from too-frequent changes. If a patient
removes pouch for bathing, have the
patient use a mild soap without oils or
deodorants. Make sure the patient rinses
all soap residue off. Drying ensures
adhesion of pouch and prevention of
skin irritation under pouch.

20. Document.
• Document type of pouch and skin
barrier applied.