COLOSTOMY CARE

Reasons for Performing a Colostomy
When feces cannot progress naturally from the colon to the anus
When it is more desirable or manageable to divert the feces, as for paraplegics
In any condition where the rectum or anus is nonfunctional because of disease, a birth defect or a traumatic condition.
It is performed to divert the fecal flow away from an area of inflammation or around an operative area

General Procedure for Changing an Ostomy Pouch

Assessment
Identify the type of ostomy the patient has and its location (Bowel Urinary Diversion)
Assess the skin integrity around the stoma and as general appearance
Note the amount and character of any fecal material or urine in the pouch
Determine whether the patient is being taught self-care at the moment

Planning
Wash your hands
Gather the equipment needed in changing a pouch or dressing
Cleansing supplies including tissues, warm water, mild soap, wash cloth and a towel
Clean pouch of the type currently being used
Seal or use tape to prevent leakage
Clean belt
Dressing materials
Receptacle for the soiled pouch or dressing (bedpan, paper bag/newspaper for wrapping)
Protective spray
Clean gloves
Determine whether the patient is to participate actively
Choose the appropriate location in performing the procedure (bathroom/ bedside)

Implementation
Identify the patient
Explain the procedure to the patient
Put on clean gloves for infection
Assist the patient to the bathroom or provide privacy
Remove the soiled dressing
Using warm water and a mild soap, cleanse the skin around the stoma thoroughly. Inspect the skin for redness or irritation.
Cover the stoma with a tissue to prevent feces or urine from contacting. Change tissues as necessary during the procedure
Dry the skin around the stoma carefully, patting gently
Apply a skin protective spray if needed
Allow the skin to dry thoroughly so the pouch will adhere firmly (a hair dryer on a low setting at least 18 inches from the skin may be used)
Remove the tissue from the stoma and apply the clean pouch or dressing
Remove gloves and wash hands

Evaluation
Evaluate using the following criteria
Pouch or dressing secure
Area clean
Odor free
Patient comfortable
If the patient is being taught the procedure, add the following criteria:
Patient is able to change pouch using correct technique
Patient verbalizes understanding of key points in care

Documentation
Record the following information:
The amount, color, and consistency of the fecal material or urine in the pouch
The application of the clean pouch and dressing change
The knowledge and ability of the patient t participate in the procedure or ability to change independently.