Ateneo de Zamboanga University College of Nursing
NUSING SKILLS OUTPUT (NSO) Report No. _5_ ILEOSTOMY IRRIGATION I. DESCRIPTION: A surgically created opening between the ileum of the small intestine and the abdominal wall to allow elimination of small bowel effluent. An ileostomy is usually formed at the terminal ileum of the small bowel and is usually placed in the right lower quadrant of the abdomen. Stool from an ileostomy drains frequently (average four to five times per day) and contains proteolytic enzymes, which can be harmful to skin. II. MATERIALS/ EQUIPMENT NEEDED: Catheter Tissues Water-soluble lubricant Gauze squares Emesis or receiving basin Irrigating solution in a bowl Syringe
III. PROCEDURE Use tap water on body temperature or even a little cooler. It does help to scare the colon a bit. Never ever use water which is too warm. Believe me, I have made this mistake once and had problems for days after. Fill the container and hang it on the hook. Fill the extra water bottle. Remove your pouch. If soiled, clean the skin around the stoma and stick the sleeve in place. Some people use a silicone ring together with a belt - that is really a personal preference. Have the pegs and the gel ready. Sit on the toilet seat. Some manuals mention sitting in front of it, some people irrigate in the bathtub. Why, I wouldnt know. If you sit just like in the old days, the lower part of the sleeve hangs neatly in the water and waste drops in the water where it should go. Apply some lubricant on the cone. Open the regulator and let some water flow out. Not in the stoma, but in the sleeve or in the basin. This way the air gets out of the tube. Now gently insert the cone into your stoma, with the regulator shut. Cover the cone with the cuff of the irrigation sleeve. Press the cone firmly into your stoma. Open the regulator. At first nothing much may happen. Remember, this is your first time and even your stoma knows this. Relax, take some deep, short breaths, exhale well. Often this is enough to start the inflow of the water. Gently aim the cone in a different direction, in case the water doesnt get in. Not one stoma is alike. On some people it goes straight into the abdomen, for others it follows a slightly different direction. (You can digitally examine yourself while under the shower, but some people find this frightening.)
P a g e | 1 of 3
Let the water flow in freely, keeping the cone in place. During your first sessions this may feel uncomfortable. Just close the regulator, take some deep breaths and open the regulator once again. The process of water flowing in will take around five minutes. On some days it goes real quick, on other days it may be a little slow. Just be patient. Now for the amount of water: there seems to be an American and a European way. As if the rest of the world doesnt irrigate ;-) Americans use around 1500cc and I have even talked to people who use more. In Europe we learn to use anything between 500cc to 1000cc. Studies have shown that 500cc could be enough to irrigate. My gastro-enterologist even claims that anything in excess simply flows into the ileum, although there is a valve between the colon and ileum. Apparently this valve is not watertight. Lately there has been some concern of distending the colon by using too much water on a regular basis. Anyway, I do as my ET nurse taught me. She said to start using 800cc, but then I am a tall guy at 64 or 194 cm. After that lot is in, I keep the cone pressed against the stoma for some time until I feel the pressure building up. Be prepared. Remove the cone but make sure the cuff of the sleeve is up. Water and output may start evacuating right away with force. Close the top of the sleeve with one or two pegs. Just relax and sit back. Some people do some yoga or breath exercises to relax better, some read the paper or a book, I smoke a cigarette. I know, bad habit, but then I never overdo on alcohol, I eat healthy and always practise safe sex ;-) Now for the stool that comes out: the first part will be quite solid, almost like in the old days. Then it is on to the more watery output. The last bit will be half digested food, always very smelly and probably very gassy.
IV. DIAGRAM/ ILLUSTRATIONS:
V. NURSING RESPONSIBILITIES: 1. BEFORE PROCEDURE Greet pateint and explain procedure. Provide privacy. Position patient in Fowlers. Turn patients body towards stoma. Expose colostomy site.
P a g e | 2 of 3
Place protective sheet.
2. DURING PROCEDURE Fill irrigation bag with 500ml of prescribed solution. Hang irrigation bag with the bottom of bag is approximately at the level of patients shoulder and above stoma and expel air from the set. Wear disposable gloves and remove colostomy bag. Cleanse stoma. Fix irrigation arm with end of it pointing towards receiver (oblique). Open upper end of irrigation arm. Lubricate cone and insert into stoma not more 3. Hold cone gently but firmly against stoma to prevent backflow. Allow fluid to enter colon slowly for 5-1o minutes (faster flow). Retain fluid 5-10 seconds. Remove cone gently. Allow return irrigation fluid to drain out for 15-20 minutes.
3. AFTER PROCEDURE Remove irrigation armwith counter traction. Cleanse stoma. Apply colostomy bag. Remove disposable gloves. Make patient comfortable. Clear and clean equipments. Record and report result.
Reference: http://www.colostomycentral.com/Colostomy-Irrigation-Procedure.html http://www.scribd.com/doc/27865405/Colostomy-Irrigation-Procedure
JULY 18, 19, 20, 2013 Date
MS. CHERRYL ANN SATOR Clinical Instructors Initials EIREES JOY A. MENDOZA BSN III-D
P a g e | 3 of 3
