Download What Is a Colostomy or Ileostomy?

1
An ostomy is a surgically
created opening in
the abdomen for the
discharge of body waste.
After the ostomy is
created, your child will
expel or release stool
through a stoma.
f Ostomies that
discharge stool are
called ileostomies
or colostomies.
The stoma is the end
of the small or large
intestine that can be seen
protruding or sticking
out of the abdominal
wall. It is the new site
where stool will leave the
body and be collected
in the ostomy pouch. The size and
location of the stoma depend on the
specific operation and the shape of the abdomen.
Most stomas are similar and will:
f Stick out of the body, usually an inch or less above the skin
f Vary in size
f Be round or oval in shape
f Be red and moist (similar to the inside of your mouth)
f Have no feeling
f Be slightly swollen for the first weeks after the
operation and then shrink to their permanent size
Surgical Patient Education
Your Child’s Colostomy/Ileostomy
What Is a Colostomy
or Ileostomy?
2
Who Needs an Ostomy?
In infants, birth conditions or disease may prevent the normal flow
and drainage of stool. In children, diseases such as inflammatory
bowel disease, cancer, injury, or trauma can block the flow of
stool. If the segment of the intestine cannot be repaired, then
the surgeon will perform an ostomy to reroute the stool to a
new opening on the abdomen. Many ostomies in children are
temporary until the problem can be repaired or treated.
American College of Surgeons • Division of Education
3
Understanding Your Child’s
Digestive System
Food passes from the mouth, through the esophagus, and to
the stomach. The stomach breaks down food into small pieces
that move into the small intestine, also called the ileum.
In the small intestine, enzymes break down food into a thick
liquid. The body absorbs nutrients, vitamins, and water. The
material moves into the large intestine, also called the colon.
In the colon, water is absorbed from the stool. It becomes
thicker as it moves through the parts of the colon. Stool passes
from the colon into the rectum and is expelled through the
anus. Your child’s operation will bring a piece of either the
small or large intestine to the surface of the abdomen.
Esophagus
Stomach
Large Intestine/Colon
Small Intestine
Ileum
Anus
Sigmoid Colon
Rectum
Surgical Patient Education
Your Child’s Colostomy/Ileostomy
Ileostomy/Colostomy
4
Ileostomy
An ileostomy is the opening created
by the surgeon to bring the small
intestine (ileum) to the surface of
the abdomen. An ileostomy may
be temporary or permanent.
Colostomy
Ileostomy
Ascending Colostomy
A colostomy is the opening
created by the surgeon to bring
the colon (large intestine) to the
surface of the abdomen. There
are various kinds of colostomies,
each named for the location in
the colon where the ostomy is
formed. They are: ascending,
transverse, descending,
or sigmoid colostomy.
Ileostomy/Colostomy Output
The stool that comes out of your stoma will be liquid after
the operation. It will get thicker within several days. Stool
that drains from an ileostomy is more liquid. Ileostomies are
created higher in the intestine, and less water is absorbed from
stool. The stool draining from a colostomy is more formed. If
your rectum and part of your colon have not been removed
surgically, it is common to have mucus discharge from your
anus. Sometimes the mucus becomes firm enough to look like
stool. This type of anal discharge is not a cause for concern.
American College of Surgeons • Division of Education
5
ABOUT THE POUCH
The stool will now exit from a new opening called a stoma and
be collected in a pouch. Your child will not be able to feel or
control the stool as it leaves the body through the stoma. He or
she will need to wear an ostomy pouching system at all times.
The pouching system sticks or adheres to the
skin around the stoma. The pouch:
ff Collects stool
ff Contains the odor
ff Protects the skin around the stoma
Stool on the stoma will not cause any problems. Stool on the skin
surrounding the stoma can cause the skin to get red or irritated.
Ostomy pouching systems are lightweight and lie flat against
the body. Pouching systems come in different sizes and styles.
Your doctor or nurse certified in ostomy care can help you
choose which one is best for your child. Most people try several
types of pouches to find one that works well for them.
Surgical Patient Education
Your Child’s Colostomy/Ileostomy
Pouching Systems
6
Pouching System Types
Pouch systems are made up of the skin barrier that holds the
pouch to the skin and the pouch that collects the drainage.
They are available as a one-piece or a two-piece system.
ONE-PIECE SYSTEM
In a one-piece pouch, the pouch and skin
barrier are attached together.
T WO -PIECE SYSTEM
In a two-piece system, there is a skin
barrier and a separate attachable
pouch. The skin barrier sticks to the
skin around the stoma and protects
the skin, giving you a place to attach
the pouch. The skin barrier usually
includes a flange or rim that is used
to seal the pouch to the skin barrier.
Flange sizes are made to fit exactly to a specific pouch.
DRAINABLE POUCH
A drainable or open pouch expels waste at
the bottom of the pouch. You do not need
to remove a drainable pouch to empty it.
The pouch can remain in place for several
days. Drainable pouches are easy to empty
and are an option for ostomies that need
to be emptied several times a day.
American College of Surgeons • Division of Education
7
A closed-end pouch has no opening and
can’t be emptied. When the pouch needs
to be emptied, remove it and throw it away.
Since your child can use 2 to 5 pouches
a day, you will need to carry extras. You
will also need plastic bags to place the full
pouch in before throwing it in the trash.
A closed-end pouch is often used:
f When the pouch does not have to be emptied often
f For convenience while traveling
f During school or after-school activities
f While swimming
Surgical Patient Education
Your Child’s Colostomy/Ileostomy
CLOSED - END POUCH
8
Pouch Closure
I LEOS TO MY AN D CO LOS TO MY
A clip or roll-up-and-seal method is used to
close a pouch for a colostomy or ileostomy.
Integrated Closure
The pouch is sealed by folding or rolling
the opening, usually three times in
the same direction. Then, either press
across the opening or use Velcro® tabs
that secure around the closure.
CLAMP METHOD
When using a clamp, be sure to wrap the end or tail piece around
the clamp; tug on the clamp once while holding the bag to make
sure it doesn’t slip off. Clamps usually last a month or longer.
American College of Surgeons • Division of Education
9
Some pouches are clear or transparent, and others are opaque
(you can’t see through them). While in the hospital, the pouch
will most likely be clear or transparent. When your child goes
home, you may prefer to switch to an opaque pouch.
Pouch Size
Pouches can be small or large. The size needed depends on the size
of your child and the amount of output that your child produces
as well as personal preference. An ileostomy produces watery
output and needs to be emptied about five times a day, so a larger
pouch may be needed. Colostomy output is more formed, so a
smaller pouch
may work. A
mini-pouch is
also available.
It is smaller
and less visible
under clothes,
but it has to
be changed or
emptied more
often. The minipouch may be
convenient
during
exercise and swimming.
Pouch with Filters
Filter
Some pouches have small vents, called
filters, which allow gas to escape. Vents
deodorize gas as it filters out. It may be
helpful to use vented pouches for infants,
since babies release air that has been
swallowed when crying and sucking.
Surgical Patient Education
Your Child’s Colostomy/Ileostomy
Color
10
Pouch Covers
Pouch covers are lightweight, soft coverings that go
over the pouch. They come in a variety of colors and
prints. The coverings may decrease any uneasiness
associated with having someone see the pouch.
Pouch Belts
Some children wear an ostomy belt around their abdomen for
added security or to help keep the pouch on during activity.
Wearing a belt may be a personal choice, or the ostomy nurse
may recommend using one if your child is having difficulty
keeping the pouch in place. If your child wears an ostomy belt:
f Attach the belt so that it lies evenly against your child’s
abdomen and lies level with the pouching system.
f The belt should not be so tight
that it cuts into or leaves a deep
groove in your child’s skin.
f You should be able to place
one finger between the belt
and your child’s abdomen.
American College of Surgeons • Division of Education
11
An ostomy is a surgically created
opening in the abdomen for
the discharge of body waste.
Ostomies that discharge urine
are urostomies. After the ostomy
is created, your child will release
urine through a stoma.
The stoma is the end of the small
or large intestine that can be
seen protruding or sticking out
of the abdominal wall. It is the
new site where urine will leave
the body and be collected in
the ostomy pouch. The size and
location of the stoma depend
on the specific operation and
the shape of the abdomen.
Most stomas are
similar and will:
f Stick out of the body, usually an
inch or less above the skin
f Vary in size
f Be round or oval in shape
f Be red and moist (similar to the inside of your mouth)
f Have no feeling
f Be slightly swollen for the first weeks after the operation
and then shrink to their permanent size
Surgical Patient Education
Your Child’s Urostomy
What Is a Urostomy?
12
Urostomy
Understanding
Your Child’s
Urinary System
The urinary system includes
two kidneys, two ureters,
a bladder, and a urethra.
The kidneys make urine
by filtering water and
waste products from the
bloodstream. The urine drains
from the kidneys, through the
ureters, and empties into the
bladder. The bladder stores
the urine. Urine is expelled or
comes out when it passes from
the bladder through the urethra.
The creation of a urostomy changes how urine is emptied from the body.
The Operation
A urostomy is an operation that reroutes urine to an opening
on the surface of the abdomen. A common urostomy operation
involves removing a small section of the ileum (small intestine). The
intestine is reconnected so that it functions normally. The surgeon
uses the small piece of ileum that is removed to make a detour for
urine, which is called an ileal conduit. One end of the piece is sewn
closed, and the other end is brought to the surface of the abdomen
to form a stoma. The ureters are removed from the bladder and
attached to the new ileal conduit. Urine now flows from the kidneys,
through the ureters, out the ileal stoma, and into the collection
pouch. The surgeon can also perform the operation using a section
of the colon (large intestine), which is called a colon conduit.
American College of Surgeons • Division of Education
13
Urine will start flowing into the ostomy
pouch right after the operation. It
may be pink or red for a few days
before returning to the normal yellow
color. Because the urine is passing
through a segment of the intestine
and the intestine produces mucus,
you may see some mucus in your child’s urine.
Stent
Urostomy Stents
Due to postoperative swelling, your child may have small
temporary tubes called stents extending out of the stoma.
Stents are placed up the ureters and help keep them open. This
allows urine to drain through the stoma. They will be removed
by the surgeon or nurse once the swelling decreases.
About the Pouch
The urine will now exit from a new opening called a stoma and
be collected in a pouch. Your child will not be able to feel or
control the urine as it leaves the body through the stoma. He or
she will need to wear an ostomy pouching system at all times.
The pouching system sticks or adheres to the skin around the stoma.
The pouch:
ff Collects urine
ff Contains the odor
ff Protects the skin around the stoma
Urine on the stoma will not cause any problems. Urine on the skin
surrounding the stoma can cause the skin to get red or irritated.
Ostomy pouching systems are lightweight and lie flat against
the body. Pouching systems come in different sizes and styles.
Your doctor or certified ostomy nurse can help you choose
which one is best for your child. Most people try several
types of pouches to find one that works well for them.
Surgical Patient Education
Your Child’s Urostomy
Urostomy Output
14
Pouching System/Types
Pouch systems are made up of the skin barrier that holds the
pouch to the skin and the pouch that collects the drainage.
They are available as a one-piece or a two-piece system.
ONE-PIECE SYSTEM
In a one-piece pouch, the pouch and
skin barrier are attached together.
T WO -PIECE SYSTEM
In a two-piece
system, there is a skin barrier and a
separate attachable pouch. The skin
barrier sticks to the skin around the stoma
and protects the skin, giving you a place
to attach the pouch. The skin barrier
usually includes a flange or rim that
is used to seal the pouch to the skin
barrier. Flange sizes are made to
fit exactly to a specific pouch.
DRAINABLE POUCH
A drainable pouch
expels urine at the
bottom of the pouch.
You do not need to
remove a drainable
pouch to empty it. It
can remain in place
for several days.
All urostomy pouches
are drainable and
have a special valve
inside the pouch that
prevents the urine
from backing up around the stoma. The drain can be a tap that turns
to open or close, or a drainage nozzle that has a plug that bends into
its holder. Many pouch taps have a colored marking to indicate when
the pouch is open. The mark cannot be seen when the tap is closed.
American College of Surgeons • Division of Education
15
Your Child’s Urostomy
Color
Some pouches are clear or transparent, and others are opaque
(one can’t see through them). While in the hospital, the pouch
will most likely be clear or transparent. When your child goes
home, you may prefer to switch to an opaque pouch.
Pouch Size
Pouches can be small or large. The size that your child needs depends
on the amount of urine produced. A urostomy produces liquid
output and needs to be emptied about five times a day, so a larger
pouch may be needed. A mini-pouch is also available. It is smaller
and less visible under clothes, but it has to be emptied more often.
The mini-pouch is convenient during exercise and swimming.
Surgical Patient Education
16
Pouch Belts
Some children wear an ostomy belt around their abdomen for
added security or to help keep the pouch on during activity.
Wearing a belt may be a personal choice, or the ostomy nurse
may recommend wearing one if your child is having difficulty
keeping the pouch on. If your child wears an ostomy belt:
f Attach the belt so
that it lies evenly
against your child’s
abdomen and
lies level with the
pouching system.
f The belt
should not be
so tight that it cuts into or leaves a
deep groove in your child’s skin.
f You should be able to place
one finger between the belt
and your child’s abdomen.
Pouch Covers
Pouch covers are lightweight, soft coverings that go
over the pouch. They come in a variety of colors and
prints. The coverings may decrease any uneasiness
associated with having someone see the pouch.
American College of Surgeons • Division of Education
17
All urostomy pouches are drainable and have a valve, which
prevents urine from backing up around the stoma. During the
day, the urostomy pouch will need to be drained about every 2 to
4 hours. It will need to be drained more often if your child drinks
a large amount of fluids. Get recommendations from your child’s
doctor about how much fluid your child should be drinking.
Nighttime Drainage
All urostomy pouches can be attached to a larger drainage bag
that keeps the pouch empty while your child is sleeping.
Connecting to the drainage bag:
ff Place the adapter on the nighttime drainage bag.
ff Connect the end of the pouch to the connector of the
long tubing on the drainage bag.
Pouch
ff Open the pouch tap.
ff Unravel and free the long tubing from any kinks.
ff Drainage bags can be freestanding or
hooked to the side of your child’s bed
Disconnecting and emptying the drainage bag:
ff Remove the drainage bag
tubing from the pouch.
Adapter
ff Close the pouch.
ff Empty the urine from the drainage
bag into the toilet.
ff You may be instructed to rinse the drainage
bag with water to decrease
odor. Other bag-cleaning
products may be suggested
by your nurse or doctor.
Surgical Patient Education
Your Child’s Urostomy
Daily Care
18
American College of Surgeons • Division of Education
19
Watch and Review
f Emptying the pouch is the first skill that you will need to do
after the operation. You will use this skill most often.
f Watch the DVD, and then follow each of the steps.
SKILL: CHECK THE POUCH LEVEL
Empty or change the pouch when it is 1/3 to
1/2 full. A pouch that is too full may start to pull
away from the skin. Your child will not feel when
urine or stool comes out of his or her stoma.
You will need to check for fullness by placing
your hand over the pouch and feeling it.
SKILL: ASSUME THE PROPER POSITION
For infants or toddlers wearing diapers:
f It is easy to empty the pouch directly into the diaper when
changing a wet diaper. Remove the wet diaper and empty the
pouch. Wipe the end of the pouch with a piece of toilet paper
or diaper wipe. Close the pouch and put on a clean diaper.
Surgical Patient Education
Ostomy Skills: Emptying and changing the pouch
Empty the Pouch SKILL
20
For children who are old enough
to empty into the toilet:
There are several positions that
can be used, depending on the
child’s level of comfort and skill.
ff Sit far back on the seat
with legs spread wide.
ff Sit or stand alongside the toilet.
SKILL: EMPT Y THE URINE
Sit far back on the seat or stand over the toilet.
1. Raise the pouch opening.
2. Open the pouch by twisting the nozzle, removing
the nozzle plug, or folding down the nozzle.
3. Before lowering, pinch together the nozzle.
4. Lower the nozzle toward the toilet.
5. Release your pinched fingers
and let the urine drain.
6. When empty, tap the nozzle to
remove any last drops.
7. Close the pouch by twisting the nozzle
into the closed position, replacing the
nozzle plug, or folding up the nozzle.
Note: For children in wheelchairs, your pediatric or WOC nurse
can provide other suggestions for emptying the pouch.
American College of Surgeons • Division of Education
21
Sit far back on the seat or stand over the toilet.
1. Make sure to have a piece of
toilet paper within reach.
2. If your child stands while emptying the
pouch, he or she may want to flush the
toilet as the pouch is drained or place a few
pieces of toilet paper into the toilet bowl on
the surface of the water. Doing so prevents
the stool and toilet water from splashing
up when draining from a high distance.
3. Raise the pouch so the opening faces up.
4. Open the pouch. Unclamp or unroll
the integrated drainage outlet.
5. Lower the opening into the toilet. Slide your
hands down the pouch to push out the stool.
6. Wipe the opening off inside and
out with toilet paper or tissue.
7. If used, add pouch deodorant.
8. Reseal the pouch.
Surgical Patient Education
Ostomy Skills: Emptying and changing the pouch
SKILL: EMPT Y THE STOOL
22
Change the Pouch SKILL
Watch and Review
ff The entire system (skin barrier and pouch) will need to be changed
every 2 to 4 days. Moisture and sweat, a full and heavy pouch, and
uneven skin around the stoma can decrease the length of time the
system will stick to the skin. If any output leaks under the skin barrier
or if there is burning or itching under the barrier, change the pouch.
ff For an ileostomy or colostomy, it is easier to change the pouch
when the stoma is less active. Ideal times include first thing in
the morning, before eating, or two hours after eating.
ff For a urostomy, your child will always be producing urine,
so the pouch and barrier can be changed any time.
ff Watch the DVD, and then follow each of the steps.
S K I L L : G AT H E R YO U R S U P P L I E S
ff New pouch
ff Washcloth/wipes/paper
towel to clean the skin
ff Sizing template to measure the
size of the stoma opening
ff Pen to trace the size of the
stoma onto the skin barrier
ff Scissors to cut the opening
ff A small plastic bag for
the soiled pouch
ff Skin barrier paste (optional) to fill uneven areas in the skin
ff Skin barrier powder (optional) to absorb the moisture from weepy skin
ff Pouch deodorant (optional) to decrease the
odor when emptying the pouch
ff Skin prep if skin barrier powder is used
American College of Surgeons • Division of Education
23
1. Begin by peeling away one corner of the barrier.
2. Work around the rest of the barrier. Push down on
the skin at each point and pull the barrier away
from the skin at the same time. Some people use
adhesive remover or a piece of wet paper towel or
washcloth to help remove the pouch barrier from
the skin. For children, it may be best to avoid any
additional products that could cause a reaction.
3. Place the old pouch in a plastic waste bag.
4. If the pouch has a closure clip, do not throw
it in the trash. The clamp can be reused.
SKILL: CLEAN AND INSPEC T
1. Inspect the color of the stoma. The stoma should be red and moist.
2. Inspect the skin for redness or irritation.
The skin should look like the rest of the
skin on your child’s abdomen.
3. Clean the skin around the stoma with
warm water. Oils may keep the skin
barrier from sticking. Do not use:
zz Soap/cleaners with oil or perfume.
zz Baby wipes that have oil,
moisturizing cream or alcohol.
4. Gently pat the skin dry.
5. If the skin around the stoma is irritated or
weepy, apply skin barrier powder. The powder
will absorb the moisture. Remember that
the new barrier will not stick well if the skin
is moist. You may need to dab or spray the
powder with a skin sealant/skin prep.
Surgical Patient Education
Ostomy Skills: Emptying and changing the pouch
SKILL: REMOVE THE OLD POUCH
24
SKILL: MEASURE AND CUT THE OPENING
It is important to measure the stoma and make
sure the opening of the barrier fits right to the
edge of the stoma. For the first three months
after your child’s operation, the stoma will
continue to shrink in size as the swelling goes
down. In the beginning, the stoma will have
to be measured with each pouch change to
make sure the opening is cut to the right size.
After that, the pouches can be precut from
your template. Pouches with precut openings
to fit the stoma can also be ordered.
1. Cover the stoma opening. Place a piece
of tissue or paper towel over the stoma to
catch any leakage while you are measuring.
2. Measure the stoma. Use the measuring
grid and find the size that fits close to
the edge of the stoma where the skin
and stoma meet. If your child’s stoma
isn’t round, your WOC nurse or doctor
can make you a custom template.
3. Place the measuring grid on the back of the
pouch barrier and trace the correct size.
4. Use scissors to cut an opening in the skin
barrier, closely following the traced shape.
If you are using a one-piece system, place
your finger into the small pre-cut opening
and push away the pouch before you start to
cut. Be careful not to cut through the front of
the pouch. If you cut the pouch, do not tape
it closed. It will leak and give off an odor.
5. Center the new opening over the stoma
to make sure it fits along the stoma edge.
Re-cut and adjust the opening as needed.
To practice:
ff Gather your supplies in the skills kit.
ff Use the stoma practice model,
measuring guide, and pouch to:
zz Measure and cut an opening.
zz Apply a new pouch to the model.
American College of Surgeons • Division of Education
25
1. Remove the covering from the
back of the skin barrier.
2. Center the cut opening in the pouch’s
barrier over the stoma.
3. Place the barrier on the skin around the
stoma. Press down on all sides for 30 to 60
seconds to make sure it is firmly applied.
4. Close the opening if using a drainable pouch.
5. Lower the pouch.
6. If you use a belt to secure your
child’s pouch, clip it in place.
7. Date and keep the paper backing to use as
your template for the next pouch change.
Stoma Supplies
Keep your child’s stoma care simple. Only use powder, paste, prep,
or seals if recommended by your WOC nurse or doctor.
S K I N B A R R I E R PA S T E S
Skin barrier paste is used to fill body folds or uneven areas around the
stoma. It can create a better seal between the skin and the skin barrier.
How to Apply
Pastes are generally placed directly onto the barrier. Paste should be applied
in a very thin layer to areas where skin folds may need to be filled in. Since
most pastes contain alcohol (which may cause a stinging
feeling), it is a good idea to let the paste sit on the skin barrier
for approximately 30 seconds before attaching to the skin so
that the alcohol evaporates. If it is difficult to get the paste on
the skin barrier, then place the paste directly onto the child’s
skin. Pastes should not irritate your child’s skin. If your child
develops a reaction to any type of paste, then try another brand.
Skin Barrier Rings
A barrier ring may be used to fill gaps where the
pouch skin barrier may leak. Barrier rings are easy
to work with and contain no alcohol. While they
can be cut or molded into any shape, the more
they are touched, the less sticky they become.
Surgical Patient Education
Ostomy Skills: Emptying and changing the pouch
S K I L L : A P P LY T H E N E W P O U C H
26
SKIN BARRIER POWDER
Skin barrier powder is used to help protect the skin when the skin around the
stoma becomes red or weepy. It is placed on the skin around the stoma.
How to Apply
Clean the skin with water, then pat dry. Lightly dust the irritated skin
with the powder and brush off the excess. You may have to use skin
sealant/skin prep after the powder in order for the pouching system
to stick to the skin. Dab on the skin prep. Do not wipe, as doing
so removes the powder. Then apply the pouching system.
SKIN BARRIER WIPE/SEAL ANT
Skin barrier wipe/sealant is a liquid skin barrier. It comes in a spray,
wipe, or gel. It is used to put a plastic-like coating on the skin. It
may help the pouching system stick better. It can serve as a coating
if your child has skin that tears easily. Make sure the barrier dries
completely before applying the pouching system on the skin.
POUCH DEODORANT
The ostomy pouch is odor-proof, so the only time an odor will be noticeable
is when you empty the pouch. Pouch deodorant comes in drop and spray
form. The deodorant is placed in the empty pouch after draining/emptying.
ADHESIVE REMOVER
Adhesive removers are used to remove skin barrier tape and sticky
residue. You will need to wash the oily remover from your child’s
skin with soap and water before applying the new pouch.
American College of Surgeons • Division of Education
27
Irritated and Red Skin
The skin around your child’s stoma can become irritated and red. This is the
most common problem for new ostomy patients. It is most often due to stool or
urine on the skin, or from tape and barriers pulling off the top layer of skin.
W H AT YO U C A N D O
ff Check your child’s skin with each pouch change.
ff Size the stoma and cut the barrier to fit the stoma.
ff Do not let your child wear the skin barrier too long. Suggested
wear time is 3 to 5 days. Wear time can depend on how often you
empty your child’s pouch and your child’s level of activity.
ff If the skin is irritated or weepy (wet), apply skin barrier powder. Lightly
apply the powder and brush off the excess. You may have to use skin
sealant/skin prep after the powder. Then apply the pouching system.
ff If there is seepage of stool or urine onto your child’s skin or by a
skin fold, you may try skin barrier paste to fill in any gaps.
ff Measure your child’s stoma during each pouch change for the first 3
months after your child’s operation. Your child’s stoma will change in
shape and size as his or her body heals. It is best not to buy pre-cut
barriers until at least 3 months after your child’s ostomy operation.
ff Don’t delay in asking for help. One visit with a WOC nurse could
save you from going through extensive trial and error.
This image shows skin redness directly above the stoma
site. This is possibly due to the barrier not being cut to
the correct size. If the child’s skin is weepy, apply stoma
powder, resize the barrier, and apply. The site should
look better with the next pouch change in 3 to 5 days.
This image shows irritated and red skin around the entire
stoma site. This is possibly due to sensitivity or stripping
the top layer of skin away when removing the barrier.
You may need to be gentler when removing tape,
use an adhesive remover, or try a different barrier.
Surgical Patient Education
Problem Solving
Problem Solving
28
Barrier Not Sticking
W H AT YO U C A N D O
If the barrier is not sticking, you may want to try:
ff Clean the skin with water. If you use soap or any wipes, be sure to rinse the
area well with water to make sure there is no residue left on the child’s skin.
ff Make sure the child’s skin is totally dry.
ff Warm the barrier before putting it in place. Some patients find
using a hair dryer on low for a few seconds may help.
ff If your child is using 2 to 3 barriers daily because of leakage or the barrier
is not sticking, contact your WOC nurse or doctor for additional help.
SIGNS OF INFEC TION
Redness around the edges of the stoma while it is healing is normal.
ff If your child has redness, tenderness, and
pain that extends 1/2 inch around the incision
or stoma, or white/beige fluid draining in
the area, call your surgeon or WOC nurse.
ff If your child has redness, itchiness, and small
dots under your barrier without any signs
of leakage, he or she may have a fungal
infection. Contact your doctor or WOC nurse
for medication to treat the infection.
Diarrhea
Stool is watery because it passes through the intestine very
quickly, before the water and electrolytes are absorbed.
W H AT YO U C A N D O
ff Keep track of how many times you have to empty your child’s pouch. If you
notice that the stool is more liquid or you are having to empty the pouch more
often than usual, your child is at a higher risk of becoming dehydrated.
ff Watch for signs of dehydration. These include dry mouth and
tongue, feeling thirsty, low urine output (for example, only going
small amounts or going less than twice per day), dizziness, or
weight loss of more than 2 to 3 pounds over a few days.
American College of Surgeons • Division of Education
29
zz Common oral replacement fluids include Pedialyte,
Gatorade, and salted vegetable or chicken broth.
ff Risk of dehydration and salt loss are especially
concerning for the infant ileostomy patient.
ff For children, encourage drinking 8 to 10 four-ounce glasses
of water per day as part of their regular routine.
Bleeding
You may see a spot of blood on your child’s stoma, especially when cleaning
or changing the pouch. The stoma has a good blood supply and no longer
has the protection of your child’s skin, so a spot of blood is normal.
W H AT YO U C A N D O
ff Make sure the bleeding has stopped after a pouch change.
The bleeding should stop within a few minutes.
ff You can use a moist cloth and apply mild pressure for a minute.
ff Contact your surgeon or WOC nurse if you see blood in
your child’s pouch or the bleeding increases.
Stoma Prolapse
Stoma prolapse means the stoma becomes longer and sticks
out (protrudes) higher above the surrounding skin.
W H AT YO U C A N D O
ff As long as the stoma remains red and stays
moist, this is not a medical emergency.
ff Contact your surgeon or nurse and let them
know this has happened. Let them know if
you need help with applying your pouch.
Surgical Patient Education
Problem Solving
ff Call your doctor or nurse. They will guide you on what oral solution your child
should drink and how to adjust his or her diet. Medication may be prescribed that
can slow down your child’s intestines and decrease the amount of stool loss.
30
Stoma Retraction
Stoma retraction means the stoma is at or below the
skin level. It looks like it is shrinking.
W H AT YO U C A N D O
ff As long as the stoma continues to put out urine
or stool, this is not a medical emergency.
ff Contact your surgeon or WOC nurse to
let them know this has happened. Stoma
retraction may make it difficult to keep a
good seal on the pouching system. Your
medical team will help you adjust your child’s
pouch system so you have a good seal.
No Output from the Ostomy
You may have an obstruction if you have cramps or nausea and no output for:
ff Ileostomy: 4 to 6 hours
ff Urostomy: 2 to 4 hours
ff Colostomy: 12 to 24 hours
Your child’s ostomy is usually active. If your child has a 4- to 6-hour period
without stool from an ileostomy or urine from a urostomy, and he or she
has cramps or nausea, your child may have an obstruction. There may
be blockage from food or internal changes, such as adhesions.
W H AT YO U C A N D O
ff Encourage your child to chew foods well, especially high-fiber foods
such as whole corn, Chinese vegetables, celery, coleslaw, skins, and
seeds. You may see these appear in the pouch undigested.
ff If you think the blockage might be due to food, gently massage
your child’s abdomen right around the stoma site. This may help
increase pressure and help the food blockage to come out.
ff Call your child’s surgeon or WOC nurse or go to your local emergency
department if your child continues to have blockage or starts to vomit.
American College of Surgeons • Division of Education
31
Contact your surgeon or WOC nurse immediately or
go to the nearest emergency room if there is:
ff A deep cut in the stoma.
ff A severe change in the color of the stoma from bright red to dark,
purplish red. A change in color could mean that there’s not enough
blood being supplied to the stoma. It is unlikely that this issue
will happen after your child is discharged from the hospital.
ff A large amount of continuous bleeding (more
than four tablespoons) into the pouch.
ff Continuous nausea and vomiting.
ff Repeatedly finding blood in the pouch, or bleeding
between the edge of the stoma and skin.
ff Continuous diarrhea with signs of dehydration.
ff Severe cramping and no output from the
stoma for a period of 4 to 6 hours.
Surgical Patient Education
Problem Solving
Medical Emergencies
32
American College of Surgeons • Division of Education
33
Overview
There’s more to having an ostomy than changing pouches. You and your child will
have to make a few other adjustments. Let’s go over the different areas of your
home management and find out how to accomplish some everyday activities.
BEDROOM
Dressing
ff Modern pouches lie pretty flat against the body. Even though the pouch is very
obvious to you and your child, it usually cannot be seen under most clothes.
Emptying the pouch when it’s one-third full will keep it from bulging. There are
also specially designed underwear and support belts to help secure the pouch.
Bicycle pants or spandex may help during periods of increased activity.
Sleeping
ff When infants and children lie on their stomachs to sleep, the pressure of
the body on a full pouch may cause leakage and soil the bed linens.
zz This problem may be prevented by emptying the pouch right before
your child goes to bed. It may also be helpful to limit foods and fluids a
few hours before bedtime. If your child is wearing closed-end pouches
during the day, switch to the longer drainable pouch at night.
ff Urostomies: Since urine continues to flow throughout the night, you will
attach your child’s urostomy pouch to the nighttime drainage bag.
B AT H R O O M
Your Child’s Medicine
ff Some changes may need to be made to medications. Let your primary care doctor and
pharmacist know that your child has an ostomy. With an ileostomy, coated tablets and
extended-release medications may come out whole into the pouch or pass through too
quickly to be fully absorbed. Medications may need to be changed to a liquid or gel.
Bathing
ff One may take a bath or shower with or without the pouch on. Many parents find it
easiest to change the pouch system during shower or bath time. Remove the entire
pouch and barrier prior to the bath or shower. Clean and inspect the skin, then apply
the new barrier and pouch. Since a urostomy and ileostomy drain often, it may work
Surgical Patient Education
Home Management and Other Resources
Home Management and
Other Resources
34
best to remove the pouch at the end of the bath or shower, which keeps stool or urine
from ending up in the tub water or on the floor of the shower. Remember that soap
and water do not hurt the stoma. Avoid lotions and oils on the peristomal skin.
Toilet
ff A drainable pouch should be emptied when it is 1/3 to 1/2 full.
Pouch deodorant can help decrease stool odor. Drinking water
or other fluid each day can help decrease urine odor.
ff If your child has a disposable pouch, he or she will need to have a supply
of disposable waste bags in the bathroom. The soiled pouch will need
to be placed in a sealed bag and then thrown in the trash.
Changing a Pouch
ff Keep supplies that you will need to change the entire pouching system
together in one location. You will need washcloths or gauze pads, mild soap,
a measuring guide, scissors, a new pouch, and a pen. If desired, you may also
need skin barrier paste, skin barrier powder, and pouch deodorant.
KITCHEN/DIE T
Ileostomy/Colostomy
ff Once you have been given the OK by your surgeon, your child can return to eating
a well-balanced diet. As you add new foods, you will see the effect they have on the
ostomy output. A dietician can work with you to help with your child’s food adjustment.
ff Foods that can cause gas:
zz Carbonated beverages, broccoli, cabbage, beans, onions, Brussels sprouts, cucumbers
zz The ostomy pouch is odor-proof, so the only time an odor
will be noticeable is when you empty the pouch
ff Odor-producing foods:
zz Fish, eggs, garlic, beans, turnips, cheese, cabbage
ff Foods that thicken stool:
zz Pudding, creamy peanut butter, baked apples/
applesauce, pasta, rice, cheese, bread, potatoes
ff Foods that can cause blockage if not chewed well:
zz Nuts, celery, coconut, mushrooms, raw crunchy vegetables, dried fruits, popcorn
American College of Surgeons • Division of Education
35
zz Beans (brown, black, kidney, pinto, lentils,
lima, soybeans), avocados, fiber-rich
cereal, oats, brown rice, turnip greens,
wheat pasta, fruit (raspberries, grapefruit,
pears, papaya, apples with skin), potatoes
with skin, sweet potatoes, yams
Urostomy
Following a urostomy, there are usually no
restrictions on foods or liquids. The ostomy
pouch is odor-proof, so the only time you will
notice an odor is when the pouch is emptied.
ff Foods that increase odor
zz Asparagus, onions, garlic
ff Drinks that decrease odor
zz Cranberry juice, noncaffeinated drinks
D I N I N G R O O M /C A F E T E R I A
ff In general, your child should be able to eat as before. You may hear noise coming from
your child’s ileostomy/colostomy during digestion. Usually the noise is barely heard
by anyone else. Eating slowly and eating less may decrease the digestive sounds.
OUTDOORS
Returning to School
ff Children can return to school as soon as they are ready, usually 2 to 4 weeks after
the operation. Initially, it may be helpful to go to school for only a half day. Speak
with your child’s surgeon about activities your child wants to participate in. There
may be some activity restrictions. If your child will be away from school for more than
2 weeks, talk with your social worker to arrange for a teacher to come to your home.
ff There should be no difficulty with the pouch while your child is at school.
Your child will need to have extra supplies (pouches and zip-top bags for
pouch disposal) and possibly a change of clothes.
ff Be prepared for what you will tell the people you meet about your child’s
operation. Tell them as much or as little as you want them to know.
You can simply say that your child has had abdominal surgery.
ff Ask your WOC nurse or surgeon for guidelines to send to your child’s nurse/school. This
should include who they should go to for help with their ostomy and pouch change.
Surgical Patient Education
Home Management and Other Resources
ff High-fiber foods that can decrease
constipation and keep stools soft:
36
Traveling
ff You may travel as normal with a little extra planning.
ff Be sure to take extra supplies, since they may not be available while
traveling. Take the phone number of where you can get your products,
just in case you have to order more in an emergency.
ff For airline travel, pack supplies in your carry-on luggage. Precut the pouches
at home, as scissors will not be allowed in a carry-on bag. You should also
have a note from your surgeon identifying that your child needs the pouching
system. This note is also good to have in case you need a private area if airport
security has to do an extended search. If you use pouch deodorants, cream,
or powder, these products will need to be placed in a sealed plastic bag.
ff For road trips, check the location of your child’s seat belt to make sure it is not
putting pressure on the pouch. If the seat belt is on the pouch, move it below or
above the pouch. Do not keep extra pouches in areas of extreme heat, such as
the back rear window or trunk of your car. If your child uses disposable pouches,
remember that you will need zip-top bags to dispose of the pouches.
Exercise and Activity
ff Speak with your child’s doctor or nurse about activities your child would like to
participate in. Heat and sweat may decrease the pouch’s barrier adhesive, so you may
have to check the pouch more often. Special belts or binders are available to keep your
child’s pouch in place. Your child can go swimming and sit in a hot tub. You will need to
make sure the pouch is supported while swimming, and that a good seal is maintained.
Suggestions include wearing a swimsuit with a high waistline and extra support, using
a closed-end mini-pouch, and checking the skin barrier to make sure there is a good
seal. Support belts specially made for added security during swimming are available.
Family Discussion
ff Your family and dear friends will want to understand more about your child’s
operation. Some things you may want to talk about include who should know
about the ostomy, who else needs to learn how to provide care, and what to do
if someone notices a pouch leak (for example, a signal system or code word).
American College of Surgeons • Division of Education
37
Medical Professionals’ Contact Information
My child’s surgeon’s name and number:
My child’s ostomy/WOC nurse’s name and number:
Other contacts:
Ostomy Care Supplies
Your child’s current pouching system is (company and product number):
Other supplies include (company name and product number):
Have your child’s supplies ordered for you before your child leaves the
hospital. It may take 1 to 2 days for the supplies to arrive. Leave the
hospital with several days of supplies in case there is a delay.
Supplies can be ordered through a local medical equipment store or pharmacy
or a national Internet order company. Check with your insurance company to
see if they have preferred providers. You can also contact the United Ostomy
Associations of America (www.uoaa.org) for suggestions. Your child may need
a prescription for ostomy supplies. If you have home health, they may be
assigned to order your supplies. Check with your child’s hospital discharge
planner for specific details for the coverage of the supplies your child needs.
Notes:
Surgical Patient Education
Home Management and Other Resources
Your Discharge
38
Additional Ostomy
Resources
American College of Surgeons
Surgical Patient Education Program
http://surgicalpatienteducation.org
1-800-621-4111
Wound, Ostomy and Continence Nurses Society (WOCN®)
www.wocn.org
1-888-224-9626
United Ostomy Associations of America (UOAA)
www.uoaa.org
1-800-826-0826
American Society of Colon and Rectal Surgeons (ASCRS)
www.fascrs.org
American Urological Association (AUA)
www.auanet.org
American College of Surgeons • Division of Education
39
Each question can have more than one correct answer.
QUESTION 1
Which statements about your child’s new stoma are true?
A. The stoma will stick out of your child’s body
B. The stoma can vary in size
C. The stoma will be dry
D. Your child can control when urine and stool leave through his or her stoma
QUESTION 2
When should you empty your child’s pouch?
A.
When it is totally filled
B.
When it is 1/3 to 1/2 full
C. Once a day
D. Every 3 to 5 days
QUESTION 3
Which steps are important when cleaning and inspecting your child’s skin?
A. Check the stoma color
B.
Check the stoma for bleeding
C. Check the skin surrounding the stoma for redness
D. Clean the skin around the stoma with alcohol
QUESTION 4
What are some of the ways you can treat skin irritation?
A.
Keep the skin barrier opening close to the edge of the stoma
B.
Don’t let your child wear the skin barrier too long
C. Use skin barrier powder if the skin around the stoma is red and weepy
D. Change the pouch if liquid seeps under the barrier
Answers:
Question 1 – A and B
Question 2 – B
Surgical Patient Education
Question 3 – A, B, and C
Question 4 – A, B, C, and D
Home Management and Other Resources
Check Your Knowledge
40
O S T O M Y TA S K F O R C E
H. Randolph Bailey, MD, FACS
Colon and Rectal Surgery
The Methodist Hospital, Houston, TX
Teri Coha, APN, CWOCN
Pediatric Surgery
Ann and Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL
Janice C. Colwell, RN, MS, CWOCN, FAAN
Ostomy Care Services
University of Chicago Medicine, Chicago, IL
Martin L. Dresner, MD, FACS
Chief, Department of Urology
Southern Arizona VA Healthcare
System, Tucson, AZ
John Easly
Patient Advocate
Ostomy Support Group of DuPage
County, Clarendon Hills, IL
Kathleen G. Lawrence, MSN, RN, CWOCN
Wound, Ostomy and Continence
Nurses Society (WOCN®)
Rutland, VT
Ann Lowry, MD, FACS
Colon-Rectal Surgery
Fairview Southdale Hospital, Minneapolis, MN
Jack McAninch, MD, FACS, FRCS
Department of Urology
San Francisco General Hospital, San Francisco, CA
Michael F. McGee, MD, FACS
Colon and Rectal Surgery
Northwestern Memorial Hospital, Chicago, IL
Marletta Reynolds, MD, FACS
Pediatric Surgery
Ann and Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL
PAT I E N T E D U C AT I O N
CO M M I T T EE
John M. Daly, MD, FACS
Ajit Sachdeva, MD, FACS, FRCSC
Eileen M. Duggan, MD
David V. Feliciano, MD, FACS
Frederick L. Greene, MD, FACS
B.J. Hancock, MD, FACS, FRCSC
Dennis H. Kraus, MD, FACS
Michael F. McGee, MD, FACS
Beth H. Sutton, MD, FACS
Michael J. Zinner, MD, FACS
A C S S TA F F
Patrice Gabler Blair, MPH
Amanda Bruggeman
Kathleen Heneghan, RN, MSN, CPN
Ajit Sachdeva, MD, FACS, FRCSC
Nancy Strand, RN, MPH
DISCLAIMER
This information is published to educate you
about preparing for your surgical procedures. It
is not intended to take the place of a discussion
with a qualified surgeon who is familiar with
your situation. It is important to remember that
each individual is different, and the reasons
and outcomes of any operation depend
upon the patient’s individual condition.
The American College of Surgeons is a scientific
and educational organization that is dedicated
to the ethical and competent practice of surgery;
it was founded to raise the standards of surgical
practice and to improve the quality of care for
the surgical patient. The ACS has endeavored
to present information for prospective surgical
patients based on current scientific information;
there is no warranty on the timeliness,
accuracy, or usefulness of this content.
David Rudzin
United Ostomy Associations of America, Inc.,
Northfield, MN
Nicolette Zuecca, MPA, CAE
Wound, Ostomy and Continence
Nurses Society (WOCN)
Mt. Laurel, NJ
The Surgical Patient Education “Pediatric
Ostomy Home Skill Kit,” developed
by the American College of Surgeons
Division of Education, is made possible
in part by the generous support of an
education grant from Coloplast Corp.
American College of Surgeons • Division of Education