Care of a Colostomy Continuing Ed Credit for the QMA

Colostomy

The purpose of this presentation is to provide a review for QMA’s on how to empty and a colostomy bag .

• A colostomy is an opening of some portion of the colon to the abdominal surface

• A stoma is an artificially created mouth or opening at the abdominal surface.

Introduction to Colostomies

• A surgical colostomy is performed when it is impossible for the feces to pass through the colon and exit the anus.

• Temporary colostomies are performed to divert the fecal flow from an inflamed area or from an operative site.

• Anatomic location influences the character and management of fecal drainage.

Locations of Colostomies

• An ascending colostomy empties from the ascending colon (right side). The drainage is liquid and contains digestive enzymes. Odor is a major concern.

• The transverse colon extends from the end of the ascending colon, across the upper mid-abdomen and joins the descending colon on the upper left side of the abdomen.

• The descending colon extends from the end of the transverse colon down to the beginning of the sigmoid colon.

• The sigmoid colon is the portion of the colon that extends from the end of the descending colon in the pelvis to the juncture of the rectum.

Another Type of Colostomy

• A double barrel colostomy is a temporary colostomy that has two openings into the colon; one into the distal end and another into the proximal end of the colon.

∙ Elimination occurs through the proximal stoma

∙ This allows the distal end of the colon to rest and heal

∙ When healing is complete, the two ends are rejoined and normal function resumes

Care of the Colostomy

NOTE* If irrigation or instillation of medications is to be conducted or the changing of the colostomy appliance, this must be performed by a licensed nurse as these procedures are NOT in the scope of practice of the QMA at Richmond State Hospital.

When to Change Appliance

• When the stool leaks on the resident’s skin.

• When the stool cannot be rinsed effectively from the appliance.

• At least 2 times per week or per physician’s order.

• Every 48 – 72 hours if the skin is reddened.

• Every 24 – 48 hours if the skin is eroded or ulcerated.

• If you see signs that an appliance needs changed, you need to report this to your nurse.

Emptying a Colostomy Bag

• Assess the bag for leakage

• Empty the bag when 1/3 full.

• If changing the appliance is not indicated, the bag can be flushed with water using a bulb-syringe, then reclamp the bag. It may be necessary to empty the contents of the ostomy bag frequently without changing the entire appliance if the resident has excessive feces.

Things to Report:

Signs of an infected ostomy site

Normal Stoma

Retracted Stoma

Prolapsed Stoma

After emptying/cleaning the colostomy

bag, be sure that you report to the nurse;

Change in the skin at the stoma site

Discoloration of the stoma

Amount of drainage from the stoma

Type of drainage from the stoma

Any leakage from colostomy bag

Resident reaction.

Documentation

Document any of the above noted information that you

reported to the nurse in the progress notes, including what

you observed, what you did for the resident and their

reaction. If you observed the patient emptying their own

colostomy bag, include if they followed proper procedure.

Changing the Appliance, Administering Medications

via Ostomy & Irrigating the Ostomy are not allowed by a

QMA at Richmond State Hospital.

You have completed the presentation on Care of a

Colostomy. To receive credit, please print out this page with your name and date printed on it and send it to Diane Mustard in Staff Development.

______________________________________ Printed Name

____________________ Date