Nur 142: irrigating a colostomy Performance Checklists: Skill 34.3

Welcome to the skill of irrigating a colostomy The directions, for this skill, were taken from your hand-out: Performance Checklists Skill 34.3 Irrigating a Colostomy Copyright 2004, Mosby, Inc. Please note, prior to reviewing your skill, for you, I have provided you some background information on what a Colostomy is. Thank you!

Introduction- What is a colostomy? The beginning introduction was taken from the American Cancer Society Website. WHAT IS A COLOSTOMY? A colostomy is an opening in the belly (abdominal wall) that is made during surgery. The end of the colon (large intestine) is brought through this opening to form a stoma. Where the stoma will be on the abdomen depends on which part of the colon is used to make it. Some colostomies are large, some small; some are on the left side of the abdomen, some are on the right, others may be in the middle.

WHAT IS A COLOSTOMY? – CONT’D An enterostomal therapy (ET) nurse or the surgeon will figure out the best location for a patients stoma. (an ET nurse is a specially trained registered nurse who take care of and teaches ostomy patients. This nurse may also be called a Wound, Ostomy and Continence nurse {WOC} or an ostomy nurse). When you look at a stoma, you are actually looking at the lining (the mucosa) of the intestine, which looks a lot like the lining of a person’s cheek. The stoma will look pink to red.

What is a colostomy?– CONT’D It is warm and moist and secretes small amounts of mucus. The way the stoma looks depends on the type of colostomy the surgeon makes and on individual body differences. It may look quite large at first, but it will shrink to its final size about 6 to 8 weeks after surgery. The shape will be round to oval. Some stomas may stick out a little, while others are flush with the skin.

WHAT IS A COLOSTOMY?– CONT’D Unlike the anus, the stoma has no valve or shut-off muscle. This means you will not be able to control of the passage of stool from the stoma, but sometimes bowel movements can be managed in other ways. There are no nerve endings in the stoma, so the stoma itself is not a source of pain or discomfort. A colostomy is not a disease, but a change in the way a patient’s body works. It surgically changes normal body function to allow stool to pass after a disease or injury.

What is a colostomy?– CONT’D Although a colostomy is a big change for the patient, the operation itself is rather simple. Digestion and body chemistry are not changed by a colostomy.

WHAT DOES A COLOSTOMY DO? INTRODUCTION After a colostomy has been created, the intestines will work just like they did before except: The colon and rectum beyond the colostomy is disconnected or removed. The anus is no longer the exit for stool.

What does a colostomy do?– CONT’D Since nutrients are absorbed in the small intestine, a colostomy does not change how the body uses food. The main functions of the colon are to absorb water, move the stool toward the anus, and then store stool in the rectum until it is passed out of the body. When a colostomy changes the stools’ route, the storage area is no longer available. The higher up in the colon the colostomy is made, the shorter the colon is. The less time the colon has to absorb water, the softer or more liquid the stool is likely to be.

WHAT DOES A COLOSTOMY DO? CONT’D A colostomy further down in the colon, near the rectum, will put out stool that has been in the intestine a longer time. Depending on the effects of illness, medicines or other forms of treatment, the longer colon can put out a more solid or formed stool. Some people with colostomies find that they are able to pass this stool at certain times of the day with or without the help of irrigation (irrigation is discussed later).

What does a colostomy do? Cont’d After surgery, some people still may feel urges and even have some discharge from the anus. This discharge is mucus, blood, and at times, stool, left from the operation. If the rectum remains after surgery, it will keep putting out mucus that can be harmlessly passed whenever a patient has the urge.

WHY HAVE A COLOSTOMY - INTRODUCTION Colostomy surgery is done for many different diseases and conditions. Certain lower bowel problems are treated by giving part of the bowel a rest. It is kept empty by keeping stool from getting to that part of the bowel. To do this, a short-term (temporary) colostomy is created so that the bowel can heal.

Why have a colostomy – cont’d This may take a few weeks, months, or even years. In time, the colostomy will be reversed (removed) and the bowel will work like it did before. When part of the colon or the rectum becomes diseased, a long-term (permanent) colostomy must be made. The diseased part of the bowel is removed or permanently rested. In this case, the colostomy is not expected to be closed in the future.

LET’S TALK ABOUT COLOSTOMY IRRIGATION The slides, in Green, were taken from the website called: WEB M.D. Again, a COLOSTOMY is an opening -- called a stoma -- that connects the colon to the surface of the abdomen. This provides a new path for waste material and gas to leave the body after part of the colon or rectum is removed because of disease or injury. Colostomy irrigation is a way to regulate bowel movements by emptying the colon at a scheduled time. The process involves infusing water into the colon through the stoma. This stimulates the colon to empty. By repeating this process regularly -- once a day or once every second day -- the colon can be trained to empty with no spillage of waste in between irrigation. Colostomy irrigation also can help you avoid constipation.

Colostomy irrigation – cont’d Colostomy irrigation is a personal decision. If you are a candidate (see below), your doctor or a nurse who is specially trained to help people with colostomies, will discuss this option with you while you are still in the hospital after your surgery. Who Is a Candidate for Colostomy Irrigation? Patients with permanent colostomies and whose opening is in the descending or sigmoid portion of the colon are good candidates for irrigation. This is because their stools tend to be more formed. People with irritable bowel syndrome, stomal problems, or stomas in the ascending or transverse colons are less likely to have success with irrigation and are, therefore, not good candidates for colostomy irrigation.

Colostomy irrigation – cont’d When Is Colostomy Irrigation Done? Colostomy irrigation is most effective when it is done about one hour after a meal, when the colon is most likely to be full. Irrigation may be done once a day or once every other day depending on your preference and ability to regulate your bowel movements. It generally takes about six weeks to eight weeks for the bowel to become regulated with irrigation. It is important to establish a routine and irrigate at the same time each day.

COLOSTOMY IRRIGATION – CONT’D What is a Colonoscopy? Colonoscopy Colonoscopy (koh-luh-NAH-skuh-pee) lets the physician look inside your entire large intestine, from the lowest part, the rectum, all the way up through the colon to the lower end of the small intestine. The procedure is used to diagnose the causes of unexplained changes in bowel habits. It is also used to look for early signs of cancer in the colon and rectum. Colonoscopy enables the physician to see inflamed tissue, abnormal growths, ulcers, bleeding, and muscle spasms.

BEGINNING OF SKILL – Irrigating a colostomy ASSESSMENT: 1. Assess frequency of defecation, character of stool, placement of stoma, and client’s regular nutritional pattern. 2. Assess time when client normally irrigates colostomy. With a new ostomy, confer with physician about whether and when irrigations can begin. Obtain written order. 3. Confer with client for best time to irrigate. 4. Assess client’s understanding of procedure and ability to perform techniques.

implementation 1. Use Standard Protocol. 2. Summarize for client how procedure will be performed. Encourage questions as you proceed. 3. Apply gloves. Position client either: A. On toilet or in chair in front of toilet, if ambulatory. B. On side, with head slightly elevated, if unable to be out of bed.

IMPLEMENTATION – CONT’D 4. For adult clients, fill irrigation bag with 500 to 1000 mL warm irrigation solution (tap water or saline solution); clear tubing of air by opening flow control clamp and allow solution to run through tubing. Close clamp. Nurse Alerts: Do not use tap water for irrigations if not suitable for drinking. Replace with bottled water. 5. Hang the irrigation solution container on a hook so that the end of the bag is no higher than client’s shoulder when sitting or 18 to 20 inches (45-50 cm) above stoma.

HERE IS AN EXAMPLE OF A COLOSTOMY IRRIGATION CHART

Implementation – cont’d 6. Remove client’s pouch by gently pushing skin from adhesive and barrier; dispose of according to hospital policy for standard precautions (save clamp if attached to pouch). 7. Place irrigation sleeve over client’s stoma. Angle sleeve for appropriate flow of fecal returns. Angle of irrigation sleeve facilitates flow of fecal returns. Adjust belt if used. 8. Lubricate tip of irrigating cone. Reach through the top of the irrigation sleeve and insert the cone gently into the stoma.

Implementation – cont’d Nurse Alert: Only use a cone tip for irrigations. Put cone securely into stoma to create a seal. 9. With client holding cone, have client open flow control clamp and allow solution to flow. Start with 500 mL; this should take 5 to 10 minutes. Adjust directions of cone to facilitate inflow of solution as needed. 10. If cramping occurs, reduce or stop flow of irrigation fluid. 11. When all the irrigation fluid has been instilled into client’s stoma, close flow control clamp and wait 15 seconds before removing irrigation cone from stoma. Close top of irritation sleeve using appropriate closure method. Discard gloves.

IMPLEMENTATION – CONT’D 12. Allow 15 to 20 minutes for initial evacuation of stool. Keep end of sleeve in toilet or bedpan. 13. Apply gloves. After initial evacuation of stool is over, dry tip of irrigation sleeve and close end with the clip or closure device. Leave in place 30 to 45 minutes while waiting for the secondary evacuation. Client may get off toilet and walk around at this time. Discard gloves. 14. Unclamp sleeve and empty any fecal contents into toilet or bedpan. Rinse sleeve by pouring a small amount of water through the top, then remove sleeve. Rinse with liquid cleanser and cool water. Hang sleeve to dry.

IMPLEMENTATION – CONT’D 15. Wipe stoma with toilet tissue to remove any stool. Put an appropriate colostomy pouch over stoma. If client is using a two-piece pouching system, place a new cap or closed-end pouch onto skin barrier. 16. Use completion Protocol.

evaluation EVALUATION: 1. Observe the amount and characteristics of the fecal material after irrigation. 2. Evaluate regularity of bowel elimination pattern. 3. Observe client’s comfort level and responses. 4. Evaluate client’s knowledge of ability to perform, and response to irrigation. Identify unexpected outcomes and intervene as necessary. Record and report intervention and client’s response.

END OF SKILL This is the end of your skill. VIDEO: Please note, while I provided you with “extra” information, in order to pass your skill, you just need to memorize the skill itself. I just added this other information to help you add to your knowledge of colostomies. Your hand-out did not have a video link accompanied with it. I have found one on you-tube & the link is below. VIDEO: Colostomy irrigation https://www.youtube.com/watch?v=xUQOmSyqlPI Please remember though, I’m not affiliated with the school, and while this video may help you, please remember to follow the directions on your hand-out. Thank you!