8 Irrigating a Colostomy
Content
IRRIGATING A COLOSTOMY Definition: People with colostomies who have ostomies of the sigmoid colon or descending colon may have the option of irrigation, which allows for the person to not wear a pouch, but rather just a gauze cap over the stoma, and to schedule irrigation for times that are convenient. To irrigate, a catheter is placed inside the stoma, and flushed with water, which allows the feces to come out of the body into an irrigation sleeve. Most colostomates irrigate once a day or every other day, though this depends on the person, their food intake, and their healt Purposes:
1. To distend the bowel sufficiently to stimulate peristalsis, which causes evacuation to occur Equipments: •
Moisture resistant bag
•
Lubricant
•
Colostomy appliance and
•
Clean gloves
dressings
•
Bath blanket
•
Irrigation equipment
•
IV pole to suspend the irrigation
•
A bag to hold the solutions
•
Disposable stoma irrigation
•
Bed pad
drainage sleeve with belt
•
Bed pan
PROCEDURE 1. Determine the purpose of the irrigation and
which
stoma
is
to
be
irrigated.
Usually, the proximal stoma is irrigated, to stimulate the bowel to evacuate. However, the physician may want the distal stoma to be irrigated as well in preparation for diagnostic procedures. If there are two stomas, determine which is the distal and which is the proximal.
bag
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2.
PROCEDURE Before a colostomy irrigation:
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a. Assess the client’s readiness to select and use the equipment. Because many
types
of
irrigation
sets
are
available, clients should begin with a starter set until they are familiar with the colostomy and the problems of irrigating it. Later with the help of an enterostomal
therapy
nurse
or
a
qualified person from a surgical supply house, the client can select the set that is most appropriate. b. Auscultate the abdomen for bowel sounds. c. Palpate the abdomen for distention. 3. Explain the procedure and its purpose. The total irrigation process usually takes about 1 hour. 4. Assist the client who is to remain in bed to a side-lying position, and place a disposable bedpad on the bed in front of the client. Place the bedpan on top of the disposable pad, beneath the stoma. Assist an ambulatory client to sit on the toilet or on a commode in the bathroom
5. Ensure
that
the
client’s
gown
or
pajamas are moved out of the way to prevent soiling, and drape the person appropriately with the bath blanket to prevent undue exposure. Throughout the technique
provide
explanations,
and
encourage the client to participate as much as the client desires.
PROCEDURE 6. Hang the solution bag on IV pole so the
RATIONALE This height provides a pressure gradient
bottom of the container is at the level of
that allows fluid to flow into the colon. The
the client’s shoulder, or 30-45 cm (12-18
rate of flow can be regulated by the tubing
in.) above the stoma.
clamp.
7. Attach the colon catheter securely to the tubing. 8. Open the regular clamp, and run fluid
Air distends the bowel and can cause cramps.
through the tubing to expel all air from it. Close the clamp until ready for irrigation. 9. Don gloves. 10. Remove the soiled colostomy bag, and place it in the moisture-resistant bag.
Placing the colostomy bag in such a container prevents the transmission of micro-organisms and helps reduce odor.
11. Center the irrigation drainage sleeve over the stoma, and attach it snugly.
This prevents seepage of the fluid onto the skin.
12. Direct the lower open end of the drainage sleeve into the bedpan or between the client’s legs into the toilet. 13. If ordered, dilate the stoma: a. Lubricate the tip of the little finger. b. Gently insert the finger into the
A massaging motion relaxes the intestinal
stoma, using a massaging motion.
muscles.
c. Repeat steps a and b above, using
Stoma dilation is performed to stretch and
progressively
relax the stomal sphincter and to assess the
larger
fingers
until
maximum dilation is achieved.
direction
of
the
proximal
colon
prior
irrigation. 14. Lubricate the tip of the stoma cone or colon catheter.
Lubricating the tip of the cone or catheter eases insertion and prevents injury to the stoma
to
15. Using
PROCEDURE rotating motion,
a
catheter
or
opening
in
stoma the
cone
top
of
insert
the
RATIONALE A rotating motion on insertion helps to open
through
the
the stoma. Forcing the cone or catheter may
the
irrigation
traumatize or perforate the bowel.
drainage sleeve and gently through the stoma. Insert a catheter only 7cm (3in); insert a stoma cone just until it fits snugly. Many practitioners prefer using a cone to avoid the risk of perforating the bowel. If you have difficulty inserting the catheter or cone, do not apply force. 16. Open the tubing clamp, and allow the fluid
Fluid that is administered too quickly or is too
to flow into the bowel. If cramping occurs,
cold may cause cramps. If the fluid flows out
stop the flow until the cramps subside and
as fast as you put it in, press the stoma cone
then resume the flow.
or seal more firmly against the stoma to occlude it. If a stoma cone or seal is not available, press around the stoma with your fingers to close the stoma against the catheter.
17. After all the fluid is instilled, remove the catheter or cone and allow the colon to
Massaging the abdomen encourages initial emptying.
empty. In some agencies the stoma cone is left in place for 10-15 minutes before it is
removed.
Although
not
always
indicated, you may ask the client to gently massage the abdomen and sit quietly for 10-15
min.
until
initial
emptying
has
occurred. 18. Clean the base of the irrigation drainage sleeve, and seal the top and bottom with a drainage
clamp,
following
the
manufacturer’s instructions. 19. Encourage an ambulatory client to move around for about 30 minutes.
Complete emptying of the colon takes up to half
an
peristalsis. 20. Empty the irrigator drainage sleeve, and remove it.
hour.
Moving
around
facilitates
PROCEDURE 21. Clean the area around the stoma, and dry it thoroughly. 22. Put a colostomy appliance on the client as needed. 23. Promptly report to the nurse in charge any problems such as no fluid or stool returns, difficulties inserting the tube, peristomal skin redness or irritation, and stomal discoloration. 24. Document
all
assessments
and
interventions. Include the time of the irrigation, the type and amount of fluid instilled, the returns, and any problems experienced.
RATIONALE
1. To distend the bowel sufficiently to stimulate peristalsis, which causes evacuation to occur Equipments: •
Moisture resistant bag
•
Lubricant
•
Colostomy appliance and
•
Clean gloves
dressings
•
Bath blanket
•
Irrigation equipment
•
IV pole to suspend the irrigation
•
A bag to hold the solutions
•
Disposable stoma irrigation
•
Bed pad
drainage sleeve with belt
•
Bed pan
PROCEDURE 1. Determine the purpose of the irrigation and
which
stoma
is
to
be
irrigated.
Usually, the proximal stoma is irrigated, to stimulate the bowel to evacuate. However, the physician may want the distal stoma to be irrigated as well in preparation for diagnostic procedures. If there are two stomas, determine which is the distal and which is the proximal.
bag
RATIONALE
2.
PROCEDURE Before a colostomy irrigation:
RATIONALE
a. Assess the client’s readiness to select and use the equipment. Because many
types
of
irrigation
sets
are
available, clients should begin with a starter set until they are familiar with the colostomy and the problems of irrigating it. Later with the help of an enterostomal
therapy
nurse
or
a
qualified person from a surgical supply house, the client can select the set that is most appropriate. b. Auscultate the abdomen for bowel sounds. c. Palpate the abdomen for distention. 3. Explain the procedure and its purpose. The total irrigation process usually takes about 1 hour. 4. Assist the client who is to remain in bed to a side-lying position, and place a disposable bedpad on the bed in front of the client. Place the bedpan on top of the disposable pad, beneath the stoma. Assist an ambulatory client to sit on the toilet or on a commode in the bathroom
5. Ensure
that
the
client’s
gown
or
pajamas are moved out of the way to prevent soiling, and drape the person appropriately with the bath blanket to prevent undue exposure. Throughout the technique
provide
explanations,
and
encourage the client to participate as much as the client desires.
PROCEDURE 6. Hang the solution bag on IV pole so the
RATIONALE This height provides a pressure gradient
bottom of the container is at the level of
that allows fluid to flow into the colon. The
the client’s shoulder, or 30-45 cm (12-18
rate of flow can be regulated by the tubing
in.) above the stoma.
clamp.
7. Attach the colon catheter securely to the tubing. 8. Open the regular clamp, and run fluid
Air distends the bowel and can cause cramps.
through the tubing to expel all air from it. Close the clamp until ready for irrigation. 9. Don gloves. 10. Remove the soiled colostomy bag, and place it in the moisture-resistant bag.
Placing the colostomy bag in such a container prevents the transmission of micro-organisms and helps reduce odor.
11. Center the irrigation drainage sleeve over the stoma, and attach it snugly.
This prevents seepage of the fluid onto the skin.
12. Direct the lower open end of the drainage sleeve into the bedpan or between the client’s legs into the toilet. 13. If ordered, dilate the stoma: a. Lubricate the tip of the little finger. b. Gently insert the finger into the
A massaging motion relaxes the intestinal
stoma, using a massaging motion.
muscles.
c. Repeat steps a and b above, using
Stoma dilation is performed to stretch and
progressively
relax the stomal sphincter and to assess the
larger
fingers
until
maximum dilation is achieved.
direction
of
the
proximal
colon
prior
irrigation. 14. Lubricate the tip of the stoma cone or colon catheter.
Lubricating the tip of the cone or catheter eases insertion and prevents injury to the stoma
to
15. Using
PROCEDURE rotating motion,
a
catheter
or
opening
in
stoma the
cone
top
of
insert
the
RATIONALE A rotating motion on insertion helps to open
through
the
the stoma. Forcing the cone or catheter may
the
irrigation
traumatize or perforate the bowel.
drainage sleeve and gently through the stoma. Insert a catheter only 7cm (3in); insert a stoma cone just until it fits snugly. Many practitioners prefer using a cone to avoid the risk of perforating the bowel. If you have difficulty inserting the catheter or cone, do not apply force. 16. Open the tubing clamp, and allow the fluid
Fluid that is administered too quickly or is too
to flow into the bowel. If cramping occurs,
cold may cause cramps. If the fluid flows out
stop the flow until the cramps subside and
as fast as you put it in, press the stoma cone
then resume the flow.
or seal more firmly against the stoma to occlude it. If a stoma cone or seal is not available, press around the stoma with your fingers to close the stoma against the catheter.
17. After all the fluid is instilled, remove the catheter or cone and allow the colon to
Massaging the abdomen encourages initial emptying.
empty. In some agencies the stoma cone is left in place for 10-15 minutes before it is
removed.
Although
not
always
indicated, you may ask the client to gently massage the abdomen and sit quietly for 10-15
min.
until
initial
emptying
has
occurred. 18. Clean the base of the irrigation drainage sleeve, and seal the top and bottom with a drainage
clamp,
following
the
manufacturer’s instructions. 19. Encourage an ambulatory client to move around for about 30 minutes.
Complete emptying of the colon takes up to half
an
peristalsis. 20. Empty the irrigator drainage sleeve, and remove it.
hour.
Moving
around
facilitates
PROCEDURE 21. Clean the area around the stoma, and dry it thoroughly. 22. Put a colostomy appliance on the client as needed. 23. Promptly report to the nurse in charge any problems such as no fluid or stool returns, difficulties inserting the tube, peristomal skin redness or irritation, and stomal discoloration. 24. Document
all
assessments
and
interventions. Include the time of the irrigation, the type and amount of fluid instilled, the returns, and any problems experienced.
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