1. Cheryl Garnica Rn, CWOCN Spring 2011
OSTOMY BASICS
Cheryl Garnica Rn, CWOCN
Spring 2011

2. OBJECTIVES
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

3. THE OSTOMATE: WHO AND WHY?
Infants to elderly
Temporary or permanent
Cancer
Inflammatory bowel disease
Congenital anomalies
Trauma

4. PSYCHOLOGICAL IMPACT 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

5. FACTORS DETERMINING POUCH CHOICE & CONTAINMENT
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

6. 3 COMMON OSTOMY TYPES & CHARACTERISTICS
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

7. ILEOSTOMY Usually right side of abdomen for stoma location
Output characteristics: empty 7-9x/day;
Stool liquid to mushy
Normal volume cc/day;
High output: 1000 to 3L/day
Enzymatic output: can digest skin and cause chemical burn

8. Skin damage from uncontained ileostomy effluent

10. OSTOMY SUPPLIES: POUCHES
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)

11. OSTOMY SUPPLIES 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

12. OTHER CUT TO FIT WAFER/POUCH
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

13. 2 PIECE POUCH SYSTEMS
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”

14. CONVEX WAFERS 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

15. ADDITIONAL PRODUCTS FOR OSTOMY POUCHING
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

16. Additional products:
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

17. A Perfect Stoma: red, moist “bud” away from skin folds and creases

18. BASIC POUCHING INSTRUCTIONS: prepare skin
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

19. BASIC POUCHING INSTRUCTIONS:
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

20. 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.

21. NOT ALL STOMAS ARE PERFECT

24. Best pouch selection????

25. PROLAPSED STOMA: RECLINING

26. POUCH THAT!!

27. POUCHING SUGGESTIONS??

28. Stoma challenges

29. Mucocutaneous separation

30. Resources: Check WOCN notes for instructions on pouching
Great resource for anything ostomy!! (United Ostomy Assoc.)
Phoenix magazine
Crohns and Colitis Foundation
Wound, Ostomy, Continence Nursing Assoc.

31. The End! Thank you!