Equipment
■ Irrigation equipment:
■ One-piece system with a fluid container connected to tubing with cone; or two-piece system with a container separate from tubing and cone.
■ Irrigation sleeve; a sleeve without adhesive backing also requires a belt to hold it in place.
■ Clamp for a sleeve with an opening at the top.
■ Prescribed irrigating solution (usually 500 to 1,000 mL warm tap water, 100° to 105°F (37.8° to 40.6°C).
■ IV pole or other equipment to hang the irrigation container.
■ Chair.
■ Water-soluble lubricant.
■ Silicone-based adhesive remover.
■ Skin cleansers and barriers as recommended by your agency.
■ Toilet tissue.
■ Washcloth, towel.
■ Waterproof pad.
■ 2 pairs of procedure gloves.
■ Toilet facilities that include a flushable toilet and a hook or other device to hold the irrigation container (or bedpan or bedside commode for patients with impaired mobility).
■ New ostomy appliance and skin barrier or stoma cap cover.
■ Ostomy deodorant (optional).
■ Plastic bag for disposal of the used pouch.
Assessment
■ Assess cognitive level and mobility status.
■ Assess the patient’s ability to maintain a sitting position.
■ Evaluate the defecation pattern, nature of stool, hydration status, placement of stoma, characterics of the stoma, abdominal distention, and nutritional pattern. Assess the type of ostomy.
■ Be Safe! Do not irrigate an ileostomy.
Post-Procedure Reassessment
■ Observe:
■ Characteristics of the stool (color, amount, consistency).
■ Signs of bleeding from stoma or bowel.
■ Presence or absence of abdominal distention.
■ Patient’s tolerance of procedure (e.g., cramps, fatigue).
■ Patient’s ability to participate in the irrigation.
Key Points
■ Be Safe! Consult with the ostomy nurse and/or physician to see if colostomy irrigation is appropriate for your patient.
■ Determine the patient’s normal bowel pattern before surgery.
■ Prime the tubing before irrigation, using 500 to 1,000 mL, preferably 1,000 mL, of warm tap water.
■ Hang the solution about 45 cm (18 in.) above the stoma height.
■ Be Smart! Position the patient in front of or on the toilet or bedside commode. If the patient is immobile, place her in left side-lying (Sims’) position, and use a bedpan.
■ Prepare the new appliance before removing the existing one.
■ Don procedure gloves.
■ Examine the stoma and periostomal skin.
■ Apply the irrigation sleeve.
■ Lubricate the cone at the end of the tubing and insert it gently.
■ Open the tubing clamp and let the solution flow slowly for about 10 to 15 minutes. Then clamp the tubing and remove the cone.
■ Close the top of the irrigation sleeve with a clamp, have patient remain sitting, and allow approximately 30 minutes for evacuation.
■ Remove the sleeve, and rinse, dry, and store it.
■ Cleanse the stoma and peristomal skin with a warm washcloth.
Documentation
■ Document:
■ Your assessment of the stoma and peristomal area.
■ The amount of irrigation solution used.
■ The date and time you performed the irrigation.
■ Characteristics of the stool returned in the irrigation fluid.
■ Patient teaching.
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| The end of the irrigation sleeve should not hang down into the water |
2 comments:
Great Stoma care tips
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