Protocols for Care of Stomas

Counselling Before Stomas:

Counsel About

  • Hospital course and recovery
  • How often pouch emptied and changed
  • Show him/ her pouch and picture of stoma
  • Discuss odor, diet changes, clothes, sexuality and return to preoperative activities.

These issues must be addressed even if topic is not initiated by patient.

  • Assure patient that specialists will be available in hospital and after discharge.
  • Preoperative afternoon trial of practically applied stoma bag is quite helpful.

Stoma Site Marking:

  • Preoperative afternoon
  • Asses successively prone, sitting, standing and bending forward.

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Goals:

¾    Stoma within the rectus muscle.

¾    On a flat surface below the belt line in a location that the patient can see.

Factors to be considered:

1.  A two inch flat surface surrounding stoma is needed

2.  Skin folds, bony provenances, scars, and uneven abdominal surface are avoided.

3.  In protuberant abdomen preferably above skin fold application

4.  Site must be visible to patient.

5.  Avoid patient’s belt line

6.  When two stomas required avoid the same horizontal plane, at least at a distance of three inches from one another.

7.  Assess the use of supportive device for other problems i.e. patient on wheel chair has some special considerations (like wise orthopedic patients)

Techniques to Mark Site:

  • Tattooing i.e. Methylene blue intraderamlly
  • Marking with pen –indelible

Surgical Considerations / Basic Principal

  • Stoma height between 1 –2cm after swelling has subsided stoma patients
  • Stoma patterns as templates so that no skin is exposed between stoma and pattern edge
  • Pouch charge frequency
  • Four days for Ileostomy
  • Eight days for Colostomy

If daily or alternated day pouch charge required then stoma revision should be considered

Pouching Products

  • Skin barriers like stoma adhesive pastes.

Dietary and Fluid Management

  • Encourage patient to chew foods slowly and completely.
  • Drink plenty of fluids
  • Add ——– gradually to their diet
  • Eating small frequent meals

Encourage high colonic snacks between meals nutritional liquid supplement.

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