COLOSTOMY CARE

LEARNING
OUTCOMES
• Identify the
different
stoma and
complications
• Verbalize the
steps in
colostomy
care Colostomy care 2
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 STOMA ASSESSMENT
• Stoma should be pink to red and
moist.
• Pallor, cyanosis or dusky color
indicates poor blood supply.
• Black indicates necrosis.
• Initially, there may be some edema.
• Assess for cuts, ulcerations or any
abnormal findings.
• Assess skin around stoma.
• Note any redness or irritation.
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 ASSESSMENT
1. Identify patient using at least two identifiers.
2. Perform hand hygiene and apply clean gloves.
3. Observe existing skin barrier and pouch for leakage and checked medical record for
length of time in place. If an opaque pouch is being used, remove it to fully observe
stoma. Empty and measure effluent and dispose of such a pouch in proper
receptable.
4. Observe amount of effluent in pouch and empty it before it was half-full by
opening the pouch and draining it into a container for measurement of output.
Note consistency of effluent and record intake and output (I&O).
5. Observe stoma for type, location, color, swelling, presence of sutures, trauma, and
healing or irritation of peristomal skin.
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 ASSESSMENT
6. Inspect area for placement of stoma in relation to abdominal contours and
presence of scars or incisions. Remove and dispose of gloves; perform hand
hygiene.
7. Assess patient’s / family caregiver’s health literacy.
8. Explore patient’s attitudes, perceptions, knowledge of stoma and ostomy
care, and acceptance of stoma and change in function; discuss interest in
learning self-care. Identify others who will be helping patient after leaving
hospital.
9. Assess patient’s goals or preferences for how skill is to be performed or
what patient expected. Colostomy care 9
EQUIPMENTS
1. Colostomy supplies storage bags
and purses
2. Colostomy bags
3. Gloves
4. Special washcloths
5. Mild soap wash
6. Cream
7. Stainless steel scissors
8. Deodorant sprays Colostomy care 10
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PLANNING
1.Determine expected outcomes
following completion of
procedure.
2.Explain procedure to patient;
encourage patient’s interaction
and questions.
3.Assemble equipment at bedside
and closed room curtains or
door. Colostomy care 15
INTERVENTION
1. Have patient assume semi-reclining or
supine position (same position assumed
during assessment and pouching). If
possible, provided patient with mirror
for observation.
2. Perform hand hygiene and apply clean
gloves.
3. Place towel or disposable waterproof
barrier under patient and across
patient’s lower abdomen.
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INTERVENTION
4.If not done during assessment, remove
used pouch and skin barrier gently by
pushing skin away from barrier in
direction of hair growth. Loosen and
lift the edge with one hand and press
down on the skin near the sticky
backing with the other hand. Use
adhesive remover to facilitate removal
of skin barrier. Empty pouch and
dispose of it in an appropriate
receptacle. Measure output if needed.
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INTERVENTION
5.Clean peristomal skin gently with
warm tap water using washcloth; did
not scrub skin. If stoma is touched,
understood minor bleeding is normal.
Pat skin dry. Have washcloth handy for
additional cleaning if there is output
from the stoma while preparing
pouch.
6.Measure stoma. Expect size of stoma
to change for first 4-6 weeks after
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INTERVENTION
7.Trace pattern of stoma
measurement on pouch backing or
skin barrier.
8.Cut opening on backing or skin
barrier wafer. If using moldable or a
shape to fit barrier, used fingers to
mold shape to fit stoma.
9.Remove protective backing from
adhesive backing or water. Colostomy care 19
INTERVENTION
10.Apply pouch over stoma. Press
firmly into place around stoma and
outside edges. Have patient hold
hand over pouch to apply heat to
secure seal.
11.Close end of pouch with clip or
integrated closure. Remove drape
from patient. Help patient to
assume comfortable position.
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INTERVENTION
12.Remove and dispose of gloves
and other disposables. Perform
hand hygiene.
13.Raise side rails as appropriate
and lower bed to lowest
position.
14.Place nurse call system in an
accessible location within
patient’s reach. Colostomy care 21
EVALUATION
1.Observe condition of skin barrier and adherence of pouch to
abdominal surface.
2.Observe appearance of stoma, peristomal skin, abdominal
contours, and suture line during pouch change.
3.Note if there is presence of any flatus during pouch change.

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EVALUATION

4. Observe patient’s and family caregiver’s willingness to

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 RECORDING
1. Recorded type of pouch and skin
barrier apply; time or procedure;
amount and appearance of effluent
in pouch, location, size, and
appearance of stoma; and condition
of peristomal skin in the electronic
health record (EHR) or chart.
2. Record patient and family caregiver’s
level of participation, the teaching
that was done, and the response to
teaching.

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 HAND-OFF REPORTING
1.Report any of the
following to nurse and /
or health care provider:
abnormal appearance of
stoma, suture line,
peristomal skin, or
character of output.

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