Skill 48

Ostomy Care (Pouching)

Immediately after a fecal surgical diversion, it is necessary to place a pouch over the newly created stoma to contain effluent when the stoma begins to function. The pouch will keep the patient clean and dry, protect the skin from drainage, and provide a barrier against odor. A cut-to-fit, transparent pouching system is preferred because it will cover the peristomal skin without constricting the stoma and allow for visibility of the stoma.

In the immediate postoperative period, the stoma may be edematous and the abdomen distended. These symptoms will resolve over a 4- to 6-week period after surgery, but, during this time, it will be necessary to revise the pouching system to meet the changing size of the stoma and the changes in body contours (Dietz and Gates, 2010a).

Delegation Considerations

The skill of pouching a new ostomy/ileostomy cannot be delegated to nursing assistive personnel (NAP). In some agencies, care of an established ostomy (4 to 6 weeks or more after surgery) can be delegated to NAP. The nurse directs the NAP about:

▪ The expected amount, color, and consistency of drainage from the ostomy.

▪ The expected appearance of the stoma.

▪ Special equipment needed to complete the procedure.

▪ Changes in the patient’s stoma and surrounding skin integrity that should be reported.