[Medsport]

My patient for tomorrow has a colostomy, catheter, g-tube and also has a couple bed sores. This will be my first patient that has had any of these except the catheter. A guy who had him last week said you have to irrigate the colostomy. I never heard of that, I did have to irrigate a g-tube once. What is involved in the colostomy care? I hope there will be somebody to help me as I've only done this stuff in the lab on a "dummy" and our colostomy lesson was only a lecture. Hopefully I can get some idea to put my mind at ease because every wed. night I can't sleep wondering what my patient is going to be like. I don't know if that is normal or not?

[Achoo!]

You should be able to find it in the hospital procedure manual. This is what my book says..
1. Assemble necessary eqipment. Warm solution is amt ordered.
2. Explain procedure to pt. Assist onto commode or nearby bathroom
3. hand hygeine
4. Add irrigation solution to the container. Release clamp and allowfluid to progress throught ube before reclamping.
5.Hang container so bottom of bag will be at pts shoulder level when starting
6. Don gloves
7. Remove appliance and attach irrigation sleeve, placing drainage end in toilet bowl
8. Lubricate the end of the cone
9. Introduce solution slowly over 5 min. Hold tubing at all times solution is being instilled
10. Hold cone in place an additional 10 min after infusion
11. remove cone
12. patient may clip cone and return to ADL's
13. After soltuion has stopped flowing from stoma, remove sleeve and cleanse skin around stoma.
14. attach new appliance.

[Daytonite]

Geez! I've been working in the hospitals too long. I didn't know people were still doing colostomy irrigations. I know of a number of people who have colostomies and never irrigate them, my mother and my sister's mother-in-law are two of them. Colostomy irrigation is nothing more than an enema through the colostomy stoma. What makes it different from a regular enema is that because of the stoma's location, you have to have some special equipment so you don't end up with a mess. Also, unlike a person with an anal sphincter and rectal muscles, a person with a colostomy has no control over the poop and irrigating solution that is coming out of the stoma. And that is what makes it potentially a messy procedure if you don't set up all your special equipment for this in the right way. Here are some websites, most of them written by patients on how to irrigate a colostomy.

http://www.ostomates.org/irrigation.html - Irrigating Your Colostomy. Written by a colostomy patient, this is an article on how a patient can irrigate their own colostomy.

http://www.questdiagnostics.com/kbase/as/ug2171/how.htm - Caring for your Ostomy. Includes a section on how to irrigate a colostomy including a picture of the setup.

http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Colostomy.asp?sitearea=&level - Colostomy Guide. About 1/3 of the way down the page is the irrigation procedure. Includes drawings of the equipment needed.

http://www.ostomysupport.info/irr.html - Living with a Colostomy, Irrigation.

Medsport, you are reminding me of a young man who was in my original AA nursing class and clinical group. He just got every patient with stuff that needed done that none of us ever got. His first 5 or 6 patients in the acute hospital ended up getting coded and died. For the first year he walked around thinking he had a black cloud over his head and somebody "upstairs" had it in for him. Happy ending though. Today he's a certified nurse anesthetist and makes BIG BUCKS.

[Medsport]

It was'nt as complicated as I thought. It was basically using a syringe without the needle to inject water into the colostomy bag when you are emptying it to get all the "paste" out. I ended up changing the bag too. The instructor said I did a good job on that, but that my patient looked awful (I washed him up, but did'nt comb his hair as he is bedbound and gets it all messy again anyway and I did'nt put sheets on because he did'nt have them on in the morning-has an air mattress). I also changed his dressing without the instructor watching, so she did'nt sign the treatment book (have to have her watch tommorrow). I guess its more how they look in a nursing home than what you actually do for them...

[Megsd]

Originally Posted by Medsport

I guess its more how they look in a nursing home than what you actually do for them...

Well, sorta kinda, but not really. You need to keep in mind that you are not just there to help with physical tasks, but also to help your resident lead the most productive and satisfying life he can in spite of his limitations that put him in the nursing home. Things like having clothes that fit and are coordinated, having hair combed, nails clean and neat... these are important.

Think about how you would feel if you were stuck in bed all day with people (including visitors, family, friends, staff) coming in to see you and you were physically unable to do your hair, or your makeup, or dress nicely, or any of those things we feel we must do to be presentable. Your resident is no different. Having groomed hair not only makes them look good, it makes them feel good. And that is why we do it. Even if it will get messy again anyway. If it does... comb it again. It doesn't take a lot of time to do, and it can really boost a person's self esteem.

Sorry, it's kind of a soapbox issue for me.

[Daytonite]

Originally Posted by Medsport

It was basically using a syringe without the needle to inject water into the colostomy bag when you are emptying it to get all the "paste" out. I ended up changing the bag too.

Ha! Ha! Ha! You need to get back to that other "guy" and tell him that is not a colostomy irrigation. It's still a PIA though, isn't it? And, people who are thinking about going into nursing worry about being able to deal with seeing blood. . .

[kftaterbug]

dont let the colostomy scare you. my boyfriend has one and he worries his self to death that i might see it! they are really easy to care for. irriagtion is just flushing the bag clean after you empty it. You need to remember that your patient knows that you are a student and learning. they dont expect you to know everything, just dont use them as a guinea pig. if you tell them regardless of what comes up if you dont know how to do something you will find someone who does they will have all kinds of respect for you and will help you all they can.

[WDWpixieRN]

Originally Posted by Megsd

Having groomed hair not only makes them look good, it makes them feel good. And that is why we do it. Even if it will get messy again anyway. If it does... comb it again. It doesn't take a lot of time to do, and it can really boost a person's self esteem.Sorry, it's kind of a soapbox issue for me.

This was an interesting comment, as my last clinical pt had lung cancer that's probably returned and was in pretty bad shape....when I went to bathe him, I noticed his hair was kind of messy so I went and got the cap the hospital supplies with the soap and stuff in it already, and asked if he wanted his hair washed....he just made some of the happiest noises when I was doing that (it almost bordered on weird, but the man's sick)...I almost felt bad when I finished.....then I combed his hair, which instantly returned to bedhead status almost immediately, but I liked knowing that for at least a few minutes, he had some respite from the pain he was so obviously in and hopefully felt a bit better....

[Tweety]

Yep, cleaning out the bag by injecting water and "irrigating a colostomy" are two different things.

However, it does sound like a great patient for a student to learn and I'm glad to hear it went well.