COLOSTOMY

C O L O S T O M Y
INTRODUCTION
Colostomy comes from the word “ostomy” means an opening which is made during surgery that brings a piece of the
bowel (intestines) to the outside of the abdomen.
Colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. During this
procedure, one end of the colon is diverted through an incision in the abdominal wall to create a stoma. A stoma is the
opening in the skin where a pouch for collecting feces is attached.
Other “ostomies” include ileostomy and urostomy. An ileostomy is a diversion of the bottom of the small intestine. A
urostomy is a diversion of the tubes that carry urine out of the bladder.
Types of Colostomy
1. Loop Colostomy – usually used in emergencies and is a temporary and large stoma. A loop of the bowel is
pulled out onto the abdomen and held in place with an external device. The bowel is sutured to the abdomen
and two openings are created in one stoma; one for stool and the other is for mucus.
2. End Colostomy – a stoma is created from one end of the bowel. The other portion of the bowel is either
removed or sewn shut (Hartmann’s procedure)
3. Double Barrel Colostomy – the bowel is severed and both ends are brought out onto the abdomen. Only the
proximal stoma is functioning. It is also a temporary colostomy with two openings into the colon. The
elimination occurs through the proximal stoma.
INDICATIONS COMPLICATIONS
 Birth defects (e.g. imperforate anus)  Breathing problems

 Serious infections (diverticulitis)  Reactions to medications
 Inflammatory bowel disease  External bleeding
 Injury to the colon or rectum  Damage to nearby organs
 Partial or complete intestinal or bowel  Development of hernia at the site of surgical
blockage cut
 Rectal or colon cancer  Prolapse of the colostomy
 Wounds or fistulas in the perineum  Infection (lungs, urinary tract, belly)
 Scar tissue forming in belly and causing
intestinal blockage
 Skin irritation
 Wound breaking open
NURSING CONSIDERATIONS
PRE-OPERATIVE NURSING CARE
 Psychological Preparation: Assure the patient that Colostomy can be cared for without it interfering with daily
activities and social life
 Nutrition: a low residue diet is given for at least 1-2 days prior to the surgery.
 Care of the Bowel: “Sterilization of the bowel prior to the surgery reduce bacterial flora that can be achiebed
through administration of poorly absorbed antibiotics such as neomycin 1g q 4 for 1-3 days; laxatives and enema
can also be done.
POST-OPERATIVE NURSING CARE
 Skin Care: assess skin for sign of irritation or breakdown; apply skin barrier paste.
 Psychosocial action: the nurse should help the patient to accept the colostomy and teach patient the necessary
care and management.
 Nutrition: light and low residue diet must be given to the patient who had colostomy
 Patient Education: provide written, verbal and psychomotor instruction on colostomy care, pouch
management, skin care and irrigation for the client.
 Medications: some medication or nutritional supplements may change color, odor or consistency of stool just
like before the surgery. Patient education and post-medication observation are therefore necessary.
 Control of odor: regular change of bag, and cleaning.
SUPPLIES AND EQUIPMENTS
 Basin set
 Blades
 Needle counter
 Penrose drain
 Internal stapling instruments
 Glass rod and tubing with colostomy pouch
 Solutions – saline, water
PROCEDURE
STEPS RATIONALE
1. Perform hand hygiene This prevents the spread of microorganisms.
2. Gather supplies. Supplies include flange, ostomy bag and clip, scissors,
stoma measuring guide, waterproof pad, pencil, adhesive
remover for skin, skin prep, stomahesive paste or powder,
wet cloth, non-sterile gloves, and additional cloths
3. Identify the patient and review the Proper identification complies with agency policy.
procedure. Encourage the patient to
participate as much as possible or Encouraging patients to participate helps them adjust to
observe/assist patient as they complete the having an ostomy.
procedure.
4. Create privacy. Place waterproof pad The pad prevents the spilling of effluent on patient and
under pouch. bedsheets.
5. Apply gloves. Remove ostomy bag, and
measure and empty contents. Place old
pouching system in garbage bag.
6. Remove flange by gently pulling Gentle removal helps prevent skin tears. An adhesive
it toward the stoma. Support the skin with remover may be used to decrease skin and hair stripping.
your other hand. An adhesive remover
may be used.
If a rod is in situ, do not remove.
A rod may be used during the formation of a stoma. It can

only be removed by a physician or wound care nurse. If a
rod is in place, it can be slid to allow the pouch to be
removed.
7. Clean stoma gently by wiping with warm Aggressive cleaning can cause bleeding. If removing stoma
water. Do not use soap. adhesive paste from skin, use a dry cloth first.
8. Assess stoma and peristomal skin. A stoma should be pink to red in color, raised above skin
level, and moist.
Skin surrounding the stoma should be intact and free from

wounds, rashes, or skin breakdown. Notify wound care
nurse if you are concerned about peristomal skin.
9. Measure the stoma diameter using the The opening should be 2 mm larger than the stoma size.
measuring guide (tracing template) and cut
out stoma hole.
Trace diameter of the measuring guide Keep the measurement guide with patient supplies for
onto the flange, and cut on the outside of future use.
the pen marking.
10. Prepare skin and apply accessory products Accessory products may include stomahesive paste,
as required or according to agency policy stomahesive powder, or products used to create a skin
sealant to adhere pouching system to skin to prevent
leaking.
Wet skin will prevent the flange from adhering to the skin.
11. Remove inner backing on flange and The warmth of the hand can help the appliance adhere to the
apply flange over stoma. Leave the border skin and prevent leakage.
tape on. Apply pressure. Hold in place for
1 minute to warm the flange to meld to
patient’s body. Then remove outer border
backing and press gently to create seal.
If rod is in situ, carefully move rod back

and forth but do not pull up on rod.
12. Apply the ostomy bag. Attach the clip This prevents the effluent from soiling the patient or bed.
to the bottom of the bag.
13. Hold palm of hand over ostomy pouch

for 2 minutes to assist with appliance
The flange is heat activated
adhering to skin.
14. Clean up supplies, and place patient in

a comfortable position. Remove garbage Removing garbage helps decrease odor.
from patient’s room
15. Perform hand hygiene.
This minimizes the transmission of microorganisms
16. Document procedure. Follow agency policy for documentation. Document

appearance of stoma and peristomal skin, products used,
and patient’s ability to tolerate procedure and assistance
with procedure

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C O L O S T O M Y

 Birth defects (e.g. imperforate anus)  Breathing problems

PRE-OPERATIVE NURSING CARE

SUPPLIES AND EQUIPMENTS

1. Perform hand hygiene This prevents the spread of microorganisms.

If a rod is in situ, do not remove.

A rod may be used during the formation of a stoma. It can

Skin surrounding the stoma should be intact and free from

If rod is in situ, carefully move rod back

13. Hold palm of hand over ostomy pouch

14. Clean up supplies, and place patient in

16. Document procedure. Follow agency policy for documentation. Document

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