Colostomy Care & Colostomy Care & IrrigationIrrigation

IntroductionIntroductionA colostomy is a surgical procedure that

involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. In a colostomy, the stoma is formed from the end of the large intestine, which is drawn out through the incision and sutured to the skin. After a colostomy, feces leave the patient's body through the abdomen. A colostomy may be permanent or temporary, depending on the reasons for its use.

Colostomy irrigation is the introduction and drainage of volume of fluid to and from the colostomy.

Human Digestive SystemHuman Digestive System

PurposePurposeTo stimulate peristalsis.To evaluate feces, gas or mucus

from the colon.To cleanse the lower

gastrointestinal tract in colostomy irrigation.

To establish a regular pattern of evacuation.

To control odor from the colostomy.

Equipment and SuppliesEquipment and SuppliesIrrigating can or enema bagIrrigation solution: 500-1000 ml Normal

Saline SolutionConnecting tube with clampRubber catheter fr. 22-24Irrigating sleeve/sheath (colostomy bag)Water soluble lubricantTissue wipesEmesis basinBedpanReceptacle for soiled dressing and

disposable pouch

ProcedureProcedureSuggested Actions Rationale

1. Apply irrigating sleeve or sheath to stoma. Place end over the bedpan, commode or toilet bowl.

To prevent spillage of feces and control odor.

2. Expel air from the tubing and catheter. Insert well the lubricated gloved finger.

To prevent introduction of air into the colon which could cause abdominal cramps. To check for stoma structures and to dilate the stoma.

3. Gently insert lubricated catheter into stoma for 3-4 inches and hold firmly in place.

To prevent perforation of the colon.

4. If catheter does not advance easily, allow solution to flow while inserting the catheter. Never force the catheter.

To help relax the colon and facilitate insertion of catheter.

ProcedureProcedureSuggested Actions Rationale

5. Introduce solution slowly. If patient experiences cramps, stop flow of solution for few minutes before progressing. Allow fluid to flow for 5-10 minutes.

To prevent painful cramps.

6. Initial volume of solution is 500 ml, maybe increase up to 1000 ml with subsequent irrigations

To have effective result of the procedure.

7. Hold the catheter in place, after instillation of solutions, and then remove slowly and gently.

8. Allow drainage of solution for 10-15 minutes.

To expel water, feces and flatus adequately.

ProcedureProcedureSuggested Actions Rationale

9. Clean the skin around the stoma, dry the area.

To protect the skin from irritation.

10.Change colostomy bag. Encourage ambulation if possible.

To further stimulate peristalsis and complete irrigation return.

11.Discard contaminated articles aseptically.

12.Record the following: Time the procedure was

done. Character and amount of

fecal drainage. Reaction of patient to the

procedure

Special ConsiderationSpecial Consideration Provide privacy and psychosocial support and

comfort. Utilize the treatment time of irrigating

colostomy as the learning time for the patient to manage his colostomy independently.

Warm the solution to body temperature to enhance peristalsis and prevent abdominal cramps.

Select a convenient time for the procedure, the clients usual daily bowel movement.

Hang irrigating can 18-20 inches above the stoma (shoulder level when sitting).

Special ConsiderationSpecial ConsiderationLubricate the catheter before

insertion to prevent trauma.Place in upright position – may sit

on commode or toilet bowl. If unable to sit upright, may be placed in lateral position (depends on location of colostomy).

The client should never use more than 1000 ml, irrigate the colostomy more than once a day, or irrigate the colostomy if diarrhea is present.

Special ConsiderationSpecial ConsiderationMinimize flatus by using odor-proof

pouches and pouches with charcoal filter and limit eating gas forming foods.

Teach the client the proper application of pouch to the stoma. A healthy stoma is red and slightly raised. The skin around the stoma should be clear, without evidence of irritation.

The pouch should be changed every 4-5 days or when leakage occurs.

Thank You & Good Day!Thank You & Good Day!