As a home health care provider, we care for many home care clients that have had a colostomy. As home health caregivers, we will routinely help with maintenance of the stoma and ostomy bag. The intentions of this article are to give home health care caregivers and clients alike, and better understanding of what a Colostomy is, why clients have a Colostomy and what is need to care for clients that have had a Colostomy.
What is a Colostomy?
A Colostomy is an operation where the colon and rectum are disconnected from the intestines. A new colon is created on the front of the abdomen. The new colon is called a “stoma.”
Why do people need a Colostomy?
People need a colostomy for a variety of reasons. Some reasons include cancer, Crohn’s disease, bowel obstruction, a birth defect, or even just to improve the quality of life. People with a spinal injury or MS will often have a colostomy to improve the quality of their lives. Most people that have a colostomy don’t need to make any major changes to their lifestyle.
What is the role of the home health caregiver in Colostomy care?
The most common home health care services for Colostomy care include maintaining a healthy stoma and emptying and changing the Ostomy pouch or bag.
How to maintain a healthy Stoma?
The home health caregiver should look at the skin around the stoma each time the pouch is changed. The stomas should look pink and it should be moist. The ostomy bag has a “skin barrier” that sticks to the abdomen and holds the ostomy bag in place. It is important the size of the skin barrier is adjusted with changes in the size of the stoma. When the home health care client first has a Colostomy, the stoma tends to be larger. It gets smaller overtime, and the skin barrier needs to be adjusted for this. Sometimes if the skin barrier is on too long without changing, the skin around the stoma can become irritated. The home health caregiver should notify the nurse or physician when this happens so the irritation can be treated.
What problems with the Stoma should home health caregiver look for?
The stoma can retract. Stoma retraction is when the stoma can go down to or below the skin level. There can be a Peristomal hernia. This is when the intestines bulge into the area around the stoma. This can be painful for the home health care client. Surgery is usually needed to repair the hernia. The stoma can prolapse. This is when there is increased abdominal pressure leading to part of the intestines pushing out of the stoma. Surgery is also usually needed to fix the prolapse. The stoma may have stenosis. This is when the stoma becomes narrow. This can cause a blockage. If there is a blockage, surgery is usually needed to fix the problem. The nurse manager and physician should be notified immediately if any of these problems are observed.
Procedure for the home health care caregiver to change the ostomy pouch or bag.
- Determine if the client has a 1 piece or 2 piece ostomy pouch.
- Gather your supplies
- A new pouch
- A pouch clip or Velcro
- Scissors
- Clean towels or paper towel
- Stoma powder
- Stoma paste or a ring seal
- Skin wipes
- A measuring card and pen
- Wash your hands with soap and water following good infection control standards.
- Remove the pouch:
- 1 piece pouch – With one hand, push the skin around the pouch down and away from the adhesive skin barrier. With the other hand, pull the pouch up and away from the stoma.
- 2 piece pouch – With one hand, push the skin around the pouch down and away from the adhesive skin barrier. With the other hand, remove the seal/wafer with your other hand. Then remove the pouch.
- Put the old ostomy pouch in a plastic bag and put it in the trash.
- Clean the skin around the stoma with warm soap and water. And dry the skin.
- Check the stoma and skin around the stoma to make sure there are no problems.
- If there are no problems, wipe around the stoma with the skin wipes. If the skin is a little wet, sprinkle some stoma powder on the wet area. Let the area air dry for a few minutes.
- Measure the stoma using the stoma measuring card and a pen, making sure not to touch the measuring card to the skin. Use an ostomy pouch that is 1/8th of an inch larger than the stoma. If you have a 2 piece ostomy pouch, trace the correct size on the back of the ring seal, and cut out this size with the scissors. Make sure the edges are smooth.
- Place the new pouch:
- 1 piece pouch – Put the stoma paste around the hole on the pouch. Center the pouch over the stoma and place the adhesive skin barrier in place. Hold it there for 30 seconds to make sure it is secure.
- 2 piece pouch – Attach the pouch to the ring seal. Peal the paper off the ring seal exposing the adhesive. Put stoma paste around the hole in the seal. Center the seal around the stoma. Hold it there for 30 seconds to make sure it is secure.
- Attach any pouch clips or place the Velcro if needed.
- Wash your hands again, following proper infection control standards.
Remember that practice makes perfect. Colostomy care can be intimidating at first, but to a seasoned home health care professional, it is second nature. If you or your loved one needs home health care, please contact PHCS.
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