GI/GU: Routine ostomy care (for nursing assistant training)

An ostomy is a surgically created opening used to connect an internal organ to the abdominal wall, through which waste products, like intestinal contents, are eliminated. The opening that can be seen on the body surface is called a stoma, and it’s usually connected to an ostomy pouch, also called a bag or appliance, where stool and flatus collect. An ostomy can be permanent or temporary, and it can be necessary because of fecal incontinence, an intestinal tumor, bowel trauma, and a bowel inflammatory disease. In these circumstances, part or all of the intestine is removed, and the remaining part of the intestine is brought up through the abdominal wall to allow for elimination of waste products.

Now, depending on how much bowel is removed, an ostomy can be either an ileostomy or a colostomy. With an ileostomy, a part of the small intestine is connected to the abdominal wall. An ileostomy can be permanent when the entire large intestine is removed or temporary when it’s done to allow the large intestine to heal after trauma or surgery. With a colostomy, only part of the large intestine is removed, and the remaining part is connected to the abdominal wall. Remember that, normally, in the small intestine, the nutrients are pretty liquid because most of the water is reabsorbed in the large intestine. So, with an ileostomy, the feces are liquid, and they flow at a fairly constant rate. With a colostomy, on the other hand, feces have a different consistency depending on the location of the colostomy. So, if nearly all the large intestine was removed and the colostomy is near the beginning, feces are more liquid. If the colostomy is near the end of the digestive tract, feces are more solid.

Like ostomies, ostomy appliances also come in different shapes and sizes. There are drainable appliances, also called “open-end” appliances which are sealed with a clip or a Velcro-type system at the bottom, so they can be drained and reused. Then there are closed-end, or disposable appliances which can be removed and replaced or emptied and rinsed when full. Additionally, some appliances are pre-cut, so they come in different sizes to match the various stoma sizes. For other appliances, you’ll need to cut out the opening yourself. Another variation refers to whether or not the skin barrier is attached to the appliance. If it is, it’s a one-piece; if not, it’s a two-piece. Finally, the ostomy appliance can be connected to an ostomy belt, and sometimes appliance deodorant can be placed inside.

Now, ostomies come in different locations and sizes, but no matter the type, there are some common care tips. Close the door and bed curtains and keep the person covered as much as possible for privacy while providing ostomy care. Remember that the skin around the ostomy is in direct contact with feces, putting it at risk of irritation, so care should be taken to keep it clean. If you’re using a pre-cut ostomy appliance, the opening should match the size of the stoma. If you cut the opening yourself, measure the stoma using a measuring guide, then trace the measurement on the skin barrier. Cut the opening a little larger than the stoma, so as to not put pressure on it. The ostomy appliance can be changed when the client is standing or sitting, and it can be done in the bathroom or while the person is lying in bed. For colostomies, choose a time when the stoma is not active to provide care, such as first thing in the morning. If you’re providing routine ostomy care in bed, place a bed protector next to the client to prevent the linens from getting soiled. Make sure to use warm water for ostomy care and make sure it’s at a comfortable temperature by testing it with the inside of your wrist. And as a general rule, while providing routine ostomy care, dirty supplies go into a bedpan, and then you can dispose of them appropriately.