Hygiene - Ostomy care: Nursing skills

An ostomy is a surgically created connection between an internal organ and the outside of the body. When an ostomy is created within the abdominal wall, a piece of intestine is brought through the opening, and the part of the intestine that’s seen on the abdomen’s surface is called a stoma. 

The stoma is connected to a pouching system, also called an appliance, that’s composed of a skin barrier or adhesive wafer that attaches to the skin, and a pouch where stool and flatus collect. These ostomies can be permanent or temporary and can be necessary because of conditions like an intestinal tumor, bowel trauma, or inflammatory bowel disease; or to allow the bowel to rest and heal after surgery.

Now, an ostomy can be either an ileostomy or a colostomy depending on its location within the intestines. An ileostomy involves part of the small intestine, called the ileum; whereas a colostomy involves the part of the large intestine, or colon.

Keep in mind that normally, in the small intestine, the stool is mostly liquid because the majority of water is normally reabsorbed in the large intestine.

So, with an ileostomy, the stool is usually semi-liquid, and it flows at a fairly constant rate.

On the other hand, with a colostomy, the stool will have a different consistency depending on its location within the colon. So, if the colostomy is located near the beginning of the colon, like in the ascending colon, the stool is typically watery and loose; while if the colostomy is located near the end of the colon, like in the descending colon, the stool will be more solid.

Okay, let’s move on and discuss the types of pouching systems. There are drainable, or open-ended pouches, which are sealed with a clip or Velcro-type system at the bottom so they can be drained and reused. Then there are closed-ended, or disposable pouches which can be removed and replaced when full. Additionally, some pouching systems have pre-cut skin barriers, so they come in different sizes to match various stoma sizes. For other types, you’ll need to cut out the opening yourself.

Another variation refers to whether or not a skin barrier is attached to the pouch. If it is, it’s a one-piece; if not, it’s a two-piece.

Now, no matter the type of ostomy, there are some common care tips to keep in mind while providing ostomy care.

Before beginning, identify your patient, inform them about the procedure, and answer any questions they may have related to the procedure.

Close the door, draw the bed curtains, and keep them covered as much as possible to maintain privacy.

You can perform ostomy care when your patient is standing or sitting, or it can be done in the bathroom or while they are lying in bed.

For colostomies, you should choose a time to provide care when the stoma is not active, such as first thing in the morning. Also remember that the skin around the ostomy is in direct contact with stool, which can irritate the skin, so care should be taken to keep it clean. Remember to always use warm water for ostomy care, and you can make sure it’s at a comfortable temperature by testing it with the inside of your wrist.

Now, if you’re using a pre-cut pouching system, the opening should match the size of the stoma. If you cut the opening yourself, measure the stoma using a measuring guide, and trace the measurement on the skin barrier. Then, cut the opening a little larger than the stoma, to avoid putting pressure on it.

Now, to provide ostomy care, you’ll need two pairs of clean gloves; a towel or bed protector; a bed pan; a wash basin filled with warm water; washcloths; adhesive remover, if needed; and a clean pouching system.

In order to care for a patient with a pre-cut one-piece disposable pouching system, first raise the bed to a comfortable working height,