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 Colostomy appliance and dressings Irrigation equipment A bag to hold the solutions Disposable stoma irrigation drainage sleeve with belt Lubricant Clean gloves Bath blanket IV pole to suspend the irrigation bag Bed pad 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.

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2.

PROCEDURE Before a colostomy irrigation: a. Assess the clients 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.

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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

clients

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 bottom of the container is at the level of the clients shoulder, or 30-45 cm (12-18 in.) above the stoma.

RATIONALE This height provides a pressure gradient that allows fluid to flow into the colon. The rate of flow can be regulated by the tubing clamp.

7. Attach the colon catheter securely to the

tubing. 8. Open the regular clamp, and run fluid 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. 12. Direct the lower open end of the drainage sleeve into the bedpan or between the clients 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 stoma, using a massaging motion. c. Repeat steps a and b above, using progressively larger fingers until maximum dilation is achieved. A massaging motion relaxes the intestinal muscles. Stoma dilation is performed to stretch and relax the stomal sphincter and to assess the direction 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 of the proximal colon prior to This prevents seepage of the fluid onto the skin. Air distends the bowel and can cause cramps.

15. Using
opening

PROCEDURE rotating motion, or in stoma the top cone of

insert through

the the

RATIONALE A rotating motion on insertion helps to open the stoma. Forcing the cone or catheter may traumatize or perforate the bowel.

catheter

the

irrigation

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 to flow into the bowel. If cramping occurs, stop the flow until the cramps subside and then resume the flow. Fluid that is administered too quickly or is too cold may cause cramps. If the fluid flows out as fast as you put it in, press the stoma cone 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 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 manufacturers instructions. 19. Encourage an ambulatory client to move around for about 30 minutes. Complete emptying of the colon takes up to half an hour. Moving around facilitates peristalsis. 20. Empty the irrigator drainage sleeve, and remove it. Massaging the abdomen encourages initial emptying.

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

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interventions. Include the time of the irrigation, the type and amount of fluid instilled, the returns, and any problems experienced.