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

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

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

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

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

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

ILEOSTOMY Usually right side of abdomen for stoma location Output characteristics: empty 7-9x/day; Stool liquid to mushy Normal volume 700-1000cc/day; High output: 1000 to 3L/day Enzymatic output: can digest skin and cause chemical burn

Skin damage from uncontained ileostomy effluent

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)

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

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

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”

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

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

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

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

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

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

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.

NOT ALL STOMAS ARE PERFECT

Best pouch selection????

PROLAPSED STOMA: RECLINING

POUCH THAT!!

POUCHING SUGGESTIONS??

Stoma challenges

Mucocutaneous separation

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

The End! Thank you!