Essential Stoma Care Catherine Murray Lead Stoma Care

Essential Stoma Care Catherine Murray, Lead Stoma Care Nurse, GHT

What is a Stoma? • Derived from Greek word meaning mouth or opening. • Diversion of bowel or bladder contents onto the abdomen. • First performed in 18 th Century on wounded battle casualties. • Red/pink in colour and moist.

Types of Stoma • Colostomy - Loop or end • Ileostomy - Loop or end • Urostomy - Ileal conduit

Colostomy- Diversion of Large Bowel • • Colon Left iliac region Temporary or permanent End / loop Formed stool Flush to skin Closed pouch

Conditions Necessitating Colostomy • Diverticular Perforation • Bowel Cancer • Obstruction • Irradiation damage • Bowel ischaemia • Incontinence • Trauma • Volvulus • Congenital abnormalities Hirschsprungs disease Imperforate anus • Spinal injury • Colovaginal / colovesical fistula

Ileostomy - Diversion of Small Bowel • • Ileum Right iliac region Temporary or permanent End/loop Semi formed stool Spout Drainable pouch

Conditions Necessitating Ileostomy • • Anastomosis protection Crohns disease Ulcerative colitis Familial polyposis Obstruction Irradiation damage Trauma

Urostomy/Ileal Conduit • • Bladder cancer Interstitial cystitis Congenital Abnormality Ileum used as channel Spout Usually permanent Appliance with tap

Urostomy/Ileo Conduit • Reason for: Bladder Cancer Interstitial Cystitis Incontinence.

Choice of Appliance • Colostomy formed stool closed pouch • Ileostomy semi formed stool drainable pouch • Urostomy urine pouch with tap

Choice of Appliance • One Piece Flexible Low Profile Discreet • Convex Appliance • Two piece Robust Frequent pouch change Less skin disturbance

Changing an Appliance • Gather supplies Bowl warm water Wipes / kitchen roll New appliance Scissors Measuring guide / pen Disposal bag

Changing Appliance • Ensure privacy at all times • Be aware of body language • • Empty pouch Gently remove soiled pouch Fold in two - disposal bag Wash around stoma and surrounding skin • Inspect skin and stoma • Pat skin dry • Measure stoma and cut appliance - snug fit • Remove plastic backing • Apply from bottom up • Check closure secure • Secure disposal bag • Wash hands

Diet and the Ostomist

Diet and the Ostomist • No hard and fast rules • Promote healthy balanced diet • Trial and error • Introduce new foods slowly • Post op • Regular grazing • Transit of food erratic through operated bowel • 4 - 6 weeks lower fibre diet • Do not diet!

Diet and the Ostomist Colostomy • • • Can tolerate most foods Avoid constipation Fibre and fluids Medication Eat regularly Ileostomy • Initially some foods difficult to digest • May need long term Loperamide • Care taken with Fruit and veg skins Green leafy veg Spicy foods Fizzy drinks Onions • May need to avoid Nuts, seeds, dried fruit Sweetcorn, oranges

Urostomist and Diet • • • Plenty of fluids Cranberry juice to reduce mucus Asparagus / fish - odour Some medication can colour urine Avoid constipation

Who we are and where to find us • Gloucester Royal Hospital Level 5, Tower Block Tel: 0300 4226702 24 hr answermachine

Who we are. Where to find us • Cheltenham General Hospital West Block – opposite vascular lab Tel: 0300 4224363 24 hr answermachine