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Cheryl Garnica Rn, CWOCN Spring 2011 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 Infants to elderly Temporary or permanent Cancer Inflammatory bowel disease Congenital anomalies Trauma 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 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 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 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 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) 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 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 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” 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 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 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 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 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 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. 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.