Colostomy Procedure

Irrigating a Colostomy EQUIPMENT Reservoir for irrigating fluids; irrigator bag or enema bag if irrigator bag not available Irrigating fluid: 500-1,500 mL lukewarm water or other solution prescribed by health care provider (Volume is titrated based on patient tolerance and results; average amount is 1,000 mL.) Irrigating tip: Cone tip or soft rubber catheter #22 or #24 with shield to prevent backflow of irrigating solution (Use only if cone not available. The cone is the preferred method to avoid possibility of bowel perforation.) Irrigation sleeve (long, large-capacity bag with opening at top to insert cone or catheter into stoma); available in different styles: Snap-on, self-adhering to skin, or held in place by belt Large tail closure Water-soluble lubricant PROCEDURE Nursing Action Rationale Preparatory phase 1 Explain the details of the procedure to the 1 Relieves anxiety and . patient and answer any questions. . promotes compliance. 2 Select a consistent time, free from 2 Establishes regularity. . distractions. If the patient is learning to . irrigate for bowel control, choose the time of day that will best fit into the patient's lifestyle. 3 Have the patient sit in front of the commode . on chair or on the commode itself, providing privacy, and comfort. 4 Hang irrigating reservoir with prescribed 4 Height of irrigation bag . solution so the bottom of the reservoir is . regulates pressure of approximately at the level of the patient's irrigant. shoulder and above the stoma. Note: Colostomy irrigation may also be performed to empty the colon of its contents (feces, gas, mucus) before a diagnostic procedure or surgery and to cleanse the colon after fecal impaction removal or with constipation. Performance phase 1 Remove pouch or covering from stoma, and 1 Allows water and feces to . apply irrigation sleeve, directing the open tail . flow directly into commode.

into the commode. 2 Open tubing clamp on the irrigating reservoir 2 Removes air from the setup; . to release a small amount of solution into the . avoids air from being commode. introduced into the colon, which can cause crampy pain. 3 Lubricate the tip of the cone/catheter, and 3 Prevents intestinal . gently insert into the stoma. Insert catheter . perforation and irritation of no more than 3 inches (7.5 cm). Hold mucous membranes. cone/shield gently, but firmly, against stoma to prevent backflow of water. 4 If catheter does not advance easily, allow 4 Slow rate relaxes bowel to . water to flow slowly while advancing catheter.. facilitate passage of NEVER FORCE CATHETER. Dilating the stoma catheter. with lubricated, gloved pinky finger may be necessary to direct cone/catheter properly. 5 Allow water to enter colon slowly over a 5- to 5 Cramping may occur from . 10-minute period. If cramping occurs, slow . too rapid flow, cold water, flow rate or clamp tubing to allow cramping excess solution, or colon to subside. If cramping does not subside, ready to function. remove cone/catheter to release contents. 6 Hold cone/shield in place 10 seconds after 6 Discourages premature . water is instilled, then gently remove . evacuation of fluid. cone/catheter from stoma. 7 As feces and water flow down sleeve, . periodically rinse sleeve with water. Allow 1015 minutes for most of the returns, then dry sleeve tail and apply tail closure. 8 Leave sleeve in place for approximately 20 8 Ambulation stimulates . more minutes while patient gets up and . peristalsis and completion moves around. of irrigation return. 9 When returns are complete, clean stomal 9 Cleanliness and dryness . area with mild soap and water; pat dry; . promote comfort. reapply pouch or covering over stoma. Follow-up phase 1 Clean equipment with soap and water; dry . and store in well-ventilated area.

1 This will control odor and . mildew, prolonging the life of equipment. 2 If applicable, the patient should use a pouch 2 It may take several months . until the colostomy is sufficiently controlled. . to establish control. The patient can then use minipouch, stoma cap, or gauze covering as desired.