Download OSTOMY BASICS

Cheryl Garnica Rn, CWOCN
Spring 2011
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Upon completion of this program, the learner
will be able to:
Verbalize basic concerns of the new ostomate
Identify basic characteristics and drainage
type of a colostomy, ileostomy and urostomy
Identify common ostomy supplies used for
fecal and urinary containment and skin
protection
Pouch a stoma
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Infants to elderly
Temporary or permanent
Cancer
Inflammatory bowel disease
Congenital anomalies
Trauma
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Containment of stool or urine and odor
control
Ability to manage ostomy independently
Relationship/Intimacy concerns
Ability to continue work
Ability to resume active lifestyle
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Type of ostomy and discharge characteristics
Stoma construction (bud, flush, retracted)
Anatomical stoma placement (skin folds,
creases and puckering around stoma)
Patient physical and mental abilities to
manage ostomy
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Colostomy:
Left or right sided stoma location
Output characteristics depend on where the
bowel was diverted
Pouch emptied 1-4x/day
Constipation possible, particularly if using
opiates for pain management
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Usually right side of abdomen for stoma
location
Output characteristics: empty 7-9x/day;
Stool liquid to mushy
Normal volume 700-1000cc/day;
High output: 1000 to 3L/day
Enzymatic output: can digest skin and cause
chemical burn
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Drainable: open ended for thicker output
(usually colostomy and ileostomy thicker output;
45mm, 57mm, 70mm)
Spouted: port with swivel tap for liquid output;
can be connected to gravity drainage bag (usually
for urine and other liquid drainage, liquid
ileostomy, 45 and 70mm)
High Output pouch: fistula or ileostomy,can
connect to gravity drainage OR cut off end and
clip up if output too thick to pass through spout
(45mm and 70mm)
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Cut to fit pouch:
One piece, cut to fit stoma, drainable: use clip
closure
Advantage: skin barrier thinner so it is more
flexible; sometimes good for in deep creases
Opening can be custom cut
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Durahesive Wafer 45mm (green box)
Cut to fit, good for urine , flexible and very
tacky, can easily be trimmed and altered to
offset stoma opening
Match with either open end drainable or
spouted pouch for urine
100mm pouch set: for large stomas and
fistulas
Cut to fit
Clip type closure and belt loops on pouch
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Color coded on box to match wafer with
correct pouch
MOLDABLE WAFERS WITH POUCH:
Green box: 45mm for stomas up to 1 ¼”
width
Red box: 57mm for stomas up to 2”
Blue box: 70mm for stomas up to 2 ½”
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Pre-sized : 1 1/8th or 1 ¼” openings
Fit 45mm pouches (green)
Uses: flush or retracted stomas, stomas with
dips and creases on sides
Applies pressure to skin around the stoma:
seals skin creases, pushes back skin folds,
helps “pop” stoma out
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Adhesive Remover: prevents skin stripping
No Sting Skin Prep: skin sealant to protect
skin from drainage and skin stripping, does
NOT help pouch stick better
Stomahesive Paste: caulking to prevent
effluent from escaping under wafer; filler for
small dips and skin creases
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Eakins seals: 2” and 4”; many uses: filling
dips, folds, creases; may substitute for paste;
framing stoma or fistula for skin protection
Stomahesive powder: for wet damaged skin;
also as a wound filler
Ostomy belts: help stabilize pouch and wafer
by pulling appliance towards body; can help
prevent leakage
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Gather supplies: gloves, pouch and wafer,
Stomahesive Paste, adhesive remover, No
Sting Skin Prep, washcloths, trash can,
scissors if needed
Gently remove old pouch with adhesive
remover
Clean skin with warm water (soap if very
dirty) and pat dry
Apply No Sting Skin Prep to peri-stomal skin
where wafer will contact skin; let dry 1-2
minutes
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Measure stoma (use widest or longest
measurement)
Cut or mold wafer opening approx. 1/16th”
larger than the stoma
Remove protective paper on wafer, apply
Stomahesive Paste in a ring (toothpaste
thickness) around the sticky side opening
only
Apply wafer to skin and press with index
finger around the stoma to seal between
stoma and skin
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Moisten the plastic flange on the wafer with
water or wet washcloth
Snap the wafer to the flange. Go around the
flange at least 3 times to make sure it is
completely connected.
Close the end of the pouch (clip , velcro or
spout).
Date the wafer.
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Check WOCN notes for instructions on
pouching
www.uoaa.org Great resource for anything
ostomy!! (United Ostomy Assoc.)
Phoenix magazine
www.ccfa.org Crohns and Colitis Foundation
www.wocn.org Wound, Ostomy, Continence
Nursing Assoc.