Patient Education

 

Patient and caregiver education should start prior to surgery in non-emergency cases to allow the patient to understand what to expect and how to adjust to living with a colostomy. Post-surgery instruction and ongoing education and problem solving are associated with better adjustment by ostomy patients. Prevention of possible complications, solutions for complications that can be handled between doctor visits, and conditions to report problems to the physician immediately will be essential features of well-rounded patient/caregiver education.

 

Pre and Post Surgery Education

 

Patients should receive careful instruction on general stoma and skin care to prevent problems and complications of colostomy maintenance. The Wound and Ostomy Care Nurse (WOCN) can work with the ostomy patient to choose the best methods and products, especially during their adjustment period when the stoma changes size, as well as being careful to adjust the instructions according to individual patient needs and preferences. This education process is essential to supporting independent decision-making by the patient.

 

Irrigation and Pouching Systems

 

Irrigation for patients who have the proper type of ostomy, meet other criteria (such as pre-operative regularity), and can accomplish irrigation on a routine basis will include introduction to equipment, methods, and proper care of capped ostomies.

 

Pouches and other products should be reviewed with the patient covering features that may be helpful, as well as explaining the pros and cons for each choice. Pouches may be reusable or disposable and some of this choice may be financially motivated. The patient should have a back-up pouch if they choose the reusable type.

 

Pouching systems may be one-piece or two-piece. One-piece pouching systems include what is called the “wafer” which adheres to the skin and is the attachment point for the pouch. This type of pouch is more flexible and is a better match for those patients involved in physical activities. However, it must be irrigated and changed more frequently than two-piece pouches. Two-piece pouches are less flexible, and therefore not as well suited to those engaging in physical activities, but can be removed, rinsed out and reused. Two-piece pouches only need to be changed about every five to seven days.

 

Patients should be instructed on emptying pouches, which should be done when the pouch is a third to a half full. Fuller pouches risk loosening the seal to the skin and leakage. Tips for changing pouches are useful reminders. The pouch should be changed on a routine basis and whenever the wafer seal to the skin is broken.

 

Changing pouches is an important feature of ostomy self-care. During pouch changes, the patient and caregiver have the opportunity to inspect the ostomy site for any redness or other signs of complication to report to their nurse and physician. While the most effective position for the patient changing a pouch may be a standing position, many patients may find it more convenient to use a sitting position. Slow removal of the wafer from the skin may reduce skin irritation. Any adhesive solvent that is used should be carefully cleaned off the skin and the skin should be completely dried. The stoma should be carefully cleaned and dried. While bleeding may occasionally occur, it should be easily stopped by applying pressure. Any additional bleeding should be reported to the WOCN and physician.

 

Replacement of the wafer should be done on clean, dry skin. If the ostomy is new or has changed for some reason, careful measurement can help to assure that the wafer opening remains at 1/8” distance from the stoma to allow for expansion during evacuation and to reduce the potential for skin irritation. A good seal should be assured before attaching the pouch in a two-piece system. Stoma adhesives can be used, as needed, to improve the seal. Tips to reducing odor can be shared with the patient, such as using charcoal filter caps or deodorizers.