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Chapter 11: Ostomy care
11.2 Ostomy Care
An ostomy is named according to the part of intestine used to construct it. A colostomy is the creation of a stoma from part of the colon (large bowel), where the intestine is brought through the abdominal wall and attached to the skin, diverting normal intestinal fecal matter through the stoma instead of the anus. An ileostomy is created from the ileum (small bowel), which is brought through the abdominal wall and used to create a stoma. A urostomy or ileal conduit is a stoma created using a piece of the intestine to divert urine to the outside of the body. The ureters are sewn to a piece of the intestine that is made into a small conduit. The conduit emerges from the abdominal wall as a stoma.
These surgeries are performed on patients with diseases such as cancer of the bowel or bladder, inflammatory bowel diseases (such as colitis or Crohn’s), or perforation of the colon. Emergencies that may require an ostomy include diverticulitis, bowel rupture, trauma, necrotic bowel, or radiation complications. An ostomy may be permanent or temporary, depending on the reason for the surgery. Other types of ostomies are called jejunostomy, double-barrel ostomy, and loop ostomy (Perry et al., 2018).
Pouching Systems (Ostomy Appliances)
Individuals with colostomies, ileostomies, or urostomies have no control over the activity of their ostomy. Persons with ostomies must wear a pouching system. The pouching system must be completely sealed to prevent leaking of the effluent and to protect the surrounding peristomal skin. The disposable pouching systems can be either a one-piece or a two-piece system consisting of a pouch (plastic bag) and a flange (skin barrier) that sit against the patient’s skin. Most flanges are flat. Sometimes a stoma that is flat or retracted can be protruded with the use of a convex flange making it easier to direct the drainage into the pouch. The pouch has an open end to allow effluent to be drained, and is closed according to the manufacturer’s design—usually a plastic clip or Velcro strip.
Different manufacturers make different types of pouching systems each designed to meet the needs of the client. Step 2 in Checklist 89 shows ostomy supplies including a flange, an ostomy bag, and a one-piece system (Perry et al., 2018; United Ostomy Association of America, 2017). The flange is cut to fit around the stoma in a way that avoids pressure or irritation on the stoma while covering the peristomal skin or a moldable flange can be used to achieve the same result (see Figure 10.18).
Ostomy pouching systems are chosen based on type of stoma (ileostomy, colostomy, urostomy), stoma characteristics (flat, raised, recessed), stoma location, patient abilities (to cut a flange and to operate the opening / closing of the pouch), skin folds, and patient preference. Pouching systems generally last from