Ostomy question

[starmickey03, MSN, RN]

I'm pretty new to home care (about 5 months) and we get lots of wounds/ostomies. In the hospital I never really worried about it because the WOC RN was always available if we were unsure/had questions about anything.

I have two questions about a new ostomy patient. She has a crease mid abdomen where her ostomy is therefore it kind of sits level with her skin as opposed to protruding like I normally see. 1) Is this normal? 2) how many hours should the ostomy go without draining any stool? I received a call from the husband stating that it's been about 6 hrs with no stool only a little liquid. Should I make a prn visit or is that an okay amount of time for no stool?

thanks!

[RachRN11]

The ideal stoma (which is pretty much just a mythical being haha) would protrude from the abdomen about an inch or so with no abdominal creases around it to make the perfect ostomy pouch seal BUT that's never the case.

So yes, it can be normal for the stoma to be at skin level (the term flush may be used in some documentations) and it can also sit in an abdominal crease (which make it seem like this was maybe an emergency surgery and no ostomy nurse was there to mark..maybe?)

I'd recommend switching the patient to a convex pouch. A convex pouch has a "bump" or gentle incline on the flange (brown, sticky part that actually sticks to skin around stoma). The convexity of the pouch applies enough pressure to gently push the stoma up and therefore guiding the stool into the pouch. Also, you can try cutting strips out of a hydrocolloid sheet and filling-in the creases to make a flat plain so the pouch can adhere better. If patient still has leaks or problems, try applying an ostomy belt for more pouch stability.

In regards to the output - what kind of stoma is it? Ileostomy or colostomy?

If it's an ileostomy (typically on the RLQ and the stool is liquid/paste-like) I suppose it'd depend on when the patient ate last, if she's on any pain medications (can slow down bowel movement) and if she has any other symptoms (severe pain in abdomen). If no other symptoms, I would tell the husband to just keep watching it and try hydrating the patient. Sometimes when patient's are dehydrated, their bowels will absorb all fluids.

If it's a colostomy (typically on LLQ and stools are much formed, soft) then 6 hours shouldn't be too worrisome as their bowel habits are more closely like "normal" non-ostomy people and may only go once or twice a day.

I hope this helps!