1. “My Patient Has An Ostomy, Now What”?
Sharon D. McCarthy, BSN, RN, CWOCN
UAB Hospital

2. Objectives List 3 types of ostomies
Describe the type of output from a colostomy, ileostomy, and urostomy based on location and construction
Describe dietary considerations for fecal and urinary diversions
Describe how to change an ostomy appliance

3. Prevalence
100,000 people in the United States undergo operations that result in a colostomy or ileostomy each year
Sheetz KH, Waits SA, Krell RW, et al (2014)

4. Stoma
A stoma is a small opening on the surface of the abdomen being surgically created in order to divert the flow of feces and/or urine.
Permanent
Temporary

5. End Loop Double barrel Distal Anastomosis Colonic Obstruction
Proctocolectomy
APR
Distal Anastomosis
Colonic Obstruction

6. Types of Ostomies Colostomy Indications Location Crohn’s Disease
Rectal or Colon CA
Hirschprung’s Disease (peds)
Imperforate Anus
Familial Polyposis
Location
Ascending
Transverse
Descending
Sigmoid

7. Types of Ostomies Ileostomy Indications Locations
Ulcerative colitis
Colon Ca
Crohn’s disease
Small bowel obstruction
Locations
Ileum/small intestines
Pediatric indications
Necrotizing Enterocolitis
Malrotation
Intussusception
Meconium ileus

8. Types of Ostomies Urostomy Interstitial Cystitis Bladder cancer
Neurogenic bladder
Exstrophy (infant)

9. Dietary Considerations
Gas Producing foods
Alcoholic beverage
Cabbage
Chewing gum
Onions
Cucumbers
Beans
Odor
Garlic
Baked beans
Cabbage
Onions
Broccoli
Eggs
Peanut butter

10. Dietary Considerations
Diarrhea control
Odor control
Increase stools
Constipation relief
Food blockage
Color changes

11. Management
One Piece Pouch
Two-piece pouch
Drainable
Closed-end

12. Flat Wafers
Convex Wafer

13. Standard wear Extended wear High flow Low flow Pressure and heat

14. Accessories Skin Protectants Pouch/Wafer Cutter Paste rings
Support belt
Paste
Ostomy Belt
Stoma Powder

15. How to Change an Ostomy Pouch

16. Wash the skin around the stoma with warm water only
Wash the skin around the stoma with warm water only. Soap can leave a residue on your skin and decrease the adherence of the pouch.
No baby wipes!
If the abdomen has hair, shave it with stoma powder and a razor. This will increase adherence.
Shave away from the stoma.

17. Measure stoma with measuring guide or tape and draw pattern onto the back of the pouch or wafer.

18. Cut out the pouch or wafer to fit the size of the stoma.
Try it on before peeling off the back to make sure it fits properly.

19. If you use paste, apply around the stoma or opening cut into wafer
If you use paste, apply around the stoma or opening cut into wafer. (Should use paste if stool is not firm. Do not use paste for urostomies)
Use damp cloth to push paste in around stoma to get a good seal.

20. Remove plastic or paper backing from wafer, center over the stoma and apply to the skin.
Rub firmly around stoma to get a good seal. May use warm moist cloth to help seal to the skin better.

21. If using a 2-piece system, then apply the pouch onto the wafer
Newer pouches have roll- up or velcro “clamps”
Make sure the spout is “off” on the urostomy pouch.

22. Ostomy Care Tips
If pouch is leaking remove it and apply another pouch.
NEVER TAPE A LEAKING POUCH!
Only use warm water when cleaning the skin around the stoma (soap/barrier wipes will cause leakage)
Only leave about 1/8 inch skin exposed when pouching
Paste protects the skin only a small amount is needed around the stoma
Stoma powder is only used when superficial skin loss occurs to the skin around the stoma

23. Sheetz, K. H. , Waits, S. A. , Krell, R. W. , Morris, A. M
Sheetz, K. H., Waits, S. A., Krell, R. W., Morris, A. M., Englesbe, M. J., Mullard, A., … Hendren, S. (2014). Complication Rates of Ostomy Surgery Are High and Vary Significantly Between Hospitals. Diseases of the Colon and Rectum, 57(5), 632–637.
Colwell, J. C., Goldberg, M. T., & Carmel, J. E. (2004). Fecal & Urinary Diversions Management Principles. St. Louis, Missouri: Mosby.

24. QUESTIONS!!!!