Colostomy and ileostomy care
Description
With an ascending or transverse colostomy or an ileostomy: child must wear an external pouch to collect emerging fecal matter, which will be watery or pasty
External pouch: helps to control odor and to protect the stoma and peristomal skin
Most disposable pouching systems used for 2 to 7 days; some models lasting longer
Pouching systems requiring immediate changing if leak develops
Ileostomy pouch possibly needing to be emptied four or five times daily
Pouching system needing to be changed when bowel is least active, usually between 2 and 4 hours after meals
Selection requires considering which system provides the best adhesive seal and skin protection
Selection also dependent on the stoma’s location and structure, availability of supplies, wear time, consistency of effluent, personal preference, and finances
Equipment
Pouching system ♦ stoma measuring guide ♦ stoma paste (if drainage is watery to pasty or stoma secretes excess mucus) ♦ plastic bag ♦ water ♦ washcloth and towel ♦ closure clamp ♦ toilet or bedpan ♦ water or pouch cleaning solution ♦ gloves ♦ facial tissues ♦ optional: ostomy belt, paper tape, mild nonmoisturizing soap, liquid skin sealant, and pouch deodorant
Essential steps
Provide privacy and emotional support.
Fitting the pouch and skin barrier
To fit a pouch with an attached skin barrier, use the stoma measuring guide.
Select the opening size that matches the stoma.
To fit an adhesive-backed pouch with a separate skin barrier, measure the stoma and select the opening that matches.
Trace the selected size opening onto the paper back of the skin barrier’s adhesive side and cut out the opening, as needed.
If the pouch has precut openings, which can be handy for a round stoma, select an opening that’s 1/8″ larger than the stoma.
If the pouch comes without an opening, cut the hole 1/8″ wider than the measured tracing.
The cut-to-fit system works best for an irregularly shaped stoma.
Avoid fitting the pouch too tightly. A constrictive opening could injure the stoma or skin tissue without the child feeling a warning discomfort.
Also avoid cutting the opening too big; it may expose the skin to fecal matter and moisture.
The child with a descending or sigmoid colostomy who has formed stools and whose ostomy doesn’t secrete much mucus may wear only a pouch. In this case, make sure the pouch opening closely matches the stoma size.
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