OSTOMY CARE
CONTENT
What is an ostomy
What is a colostomy
What is an ileostomy
What is a stoma
Closing the ostomy
Types of stomas
The bag (pouch)
Emptying the bag (pouch)
Changing the bag (pouch)
Problems
Call the doctor if….
Helpful hints
Self-help agencies
Product information
Health supply companies
WHAT IS AN OSTOMY
1. An ostomy is an opening made in the belly. The gut (intestines) is brought outside the body and attached to the skin. The baby’s bowel movements (stool) come through the opening.
2. The opening is called a stoma.
3. The baby will not have bowel movements (BMs) or stool from his bottom after the first few days following surgery.
4. The intestines may be put together again later. The diseased or injured part of the gut (intestines) has to be completely well before the doctor can put it back together.
5. Babies may need an ostomy for several reasons:
a. Imperforate anus—the intestines are not connected to the outside of the body.
b. NEC (necrotizing enterocolitis)—the intestine becomes sick and may die in areas. The sick and dying part is removed. The most common reason in a premature infant.
c. Birth problems—the intestines may be twisted, blocked or born on the outside of the baby’s body.
My baby has
WHAT IS A COLOSTOMY
1. A colostomy is when part of the large intestine (gut) is brought outside the body through an opening in the belly.
2. While the ostomy & stoma in the picture below is on the baby’s left side, a stoma may be placed on the right side, left side or in the middle of the baby’s abdomen depending on the location of the diseased or injured part of the gut (intestines) bowel.
3. Bowel movements (BMs) can be watery or thick depending on where the opening is made. Color may vary from greenish-brown to brown.
4. If the baby’s rectum was not removed during surgery, you may notice some drainage from the rectum. This is normal. The bowel still makes mucus that needs to pass out of the body.
5. We will teach you when to be concerned about your baby’s BMs.
WHAT IS AN ILEOSTOMY
1. An ileostomy is when part of the small intestines brought outside the body through an opening in the belly. The opening is usually on the right side of the body.
2. The BM is liquid or mushy (like paste) and greenish-brown or yellow in color.
3. The BM is irritating to the skin because of the higher acid content from the stomach.
WHAT IS A STOMA
1. A stoma is the part of the intestine brought to the outside of the body.
2. The stoma is shiny, red and wet (moist). It looks like the inside of your mouth.
3. The stoma may discolor temporarily (white or purple) when the baby cries. The normal color returns when the baby stops crying.
4. The stoma does not have nerves, so it does not feel pain. However, it might bleed slightly when rubbed or irritated. Do not be afraid of the stoma, it will not hurt the baby to touch it.
5. The stoma may shrink in size the first few months after surgery. You will learn to measure it regularly to make sure the pouch fits well.
6. BMs occur through the stoma many times during the day.
7. Sometimes both ends of the intestines are brought out to the skin surface so the stoma has two (2) openings. This is known as a Double-Barreled Ostomy.
a. One of these openings is called a “mucus fistula.” This lets mucus out of the end of the intestine that is not used. BM does not come out of the mucus fistula.
b. The other opening is the true ostomy. BM will come out of this opening.
8. Sometimes you will notice the stoma moving, this is normal and is the squeezing action (peristalsis) of the bowel that helps move the BM out of the bowel into the pouch.
CLOSING THE OSTOMY
1. The doctor who did the surgery will decide when the ostomy will be closed.
2. It may be as early as 1 month or as long as 1-2 years before the ostomy is closed.
3. The diseased or injured part of the gut (intestines) has to be completely well before the doctor can put it back together.
4. Closing the ostomy is an operation. Your baby is given anesthesia to make him sleep and not feel the surgery.
TYPES OF STOMAS
THE BAG (POUCH)
1. A pouch is placed over the opening so stool does not get on your baby’s skin or clothes.
2. Change the pouch every 3 days or when it leaks or starts to come off.
3. You may be given pouches for your baby when you go home.
4. Clean and dry the skin each time a new pouch is put on.
5. Empty the pouch of stool and rinse the pouch with a squirt bottle when the pouch is 1/3 full.
6. If the pouch is filled with gas but there is no stool in the bag, open the bag to let out the gas, then re-close the bag.
EMPTYING THE BAG (POUCH)
1. Open the bottom of the bag over a disposable diaper or container. Let the stool drain out.
2. Use a squeeze bottle filled with cool water to rinse the stool out of the pouch.
3. Dry the end of the pouch, fan fold, and close it with a rubber band.
4. Wash your hands.
CHANGING THE BAG (POUCH)
SUPPLIES YOU WILL NEED
1. New ostomy bag
2. Squeeze bottle filled with cool water
3. Several softnets or soft disposable pads
4. Stomahesive Powder and Skin Prep—OR—Non–Caking Cornstarch and water
5. Scissors (curved work the best)
6. Stomahesive Paste
7. Unsterile gloves.
CHANGING THE POUCH
1. Gather your supplies.
2. Wash your hands and put on gloves.
3. Remove old bag and discard.
4. Make a wick of a softnet and place it in the stoma opening to control leaking stool.
5. Wash skin around the stoma with softnets and clear warm water.
6. Dab the area (skin) around the stoma dry.
7. Apply barrier of either stomahesive powder and skin prep
--OR—
Non-caking cornstarch (dab over cornstarch with water).
8. Allow area to dry thoroughly.
9. Cut pouch to size while waiting for barrier to dry, making it smaller than the stoma.
10. Apply stomahesive paste to wafer opening ONLY! DO NOT apply to the entire wafer!
11. Place the bag over the stoma and gently press onto the skin.
12. Dispose of soiled supplies. Remove gloves and discard.
13. Wash hands.
PROBLEMS
1. Bleeding Stoma: The stoma does not feel pain, but it can bleed easily. When cleaning the stoma a small amount of bleeding is normal. If bleeding does not stop in a few minutes, apply a cold cloth to the stoma and call the doctor or sprinkle the area with stomahesive powder and call the doctor.
2. Constipation: If your baby does not have a BM every 24 hours, he may be constipated. Please call your doctor.
If your baby has an ileostomy and he does not have a BM for 2-3 hours, his belly is swollen and he becomes irritable or fretful, he may be constipated. Please call your doctor.
3. Diarrhea: You know your baby’s BM pattern. If there is more water in your baby’s BM or an increase in the amount of BM, your baby may have diarrhea. Please call your doctor.
If your baby has an ileostomy and he has more water in his BM or an increase in the amount of BM and a fever, please call your doctor.
If you have any questions about the changes in your baby’s BM pattern, please call your doctor.
4. Weepy or blisterd skin (method 1)
a. If the skin is weepy or blistered wash the area with soap and water. Rinse well and pat dry.
b. Apply a thin layer of calamine lotion using the following method:
· Do not shake the bottle.
· Let the lotion sit until the water comes to the top of the bottle.
· Pour off the top water and use the thick pink cream that settles to the bottom.
· Apply a THIN layer of the pink cream and let it dry to a pink powder.
c. Apply the pouch over the dried powder layer.
d. Change the pouch every 3-5 days or when leaking occurs.
e. Call the doctor if the area is not better in 1 week.
5. Weepy skin (method 2)
a. If the skin is weepy or blistered wash the area with soap and water. Rinse well and pat dry.
b. Sprinkle Stomahesive powder on weepy skin.
c. Dust off extra powder. Stomahesive powder will stick to weepy skin.
d. Apply pouch.
e. Repeat every 3 days or when leaking occurs until skin is healed.
f. Call the doctor if the area is not better in 1 week.
· Omit the use of paste until the skin heals.
6. Rash:
a. If skin looks like it has “prickly heat” or “diaper rash,” wash the area with water. Rinse well and pat dry.
b. Apply a THIN coat of Aseptin™ or Micro-Guard™ cream.
c. Massage the cream into the skin and let dry for at least 2 minutes.
d. Apply the pouch.
e. Repeat every 3 days or when leaking occurs until skin is healed.
f. Call the doctor if the area is not better in 1 week.
· Do Not leave the pouch off to “air” the skin. The stool will irritate the skin more.
· Do Not apply ointments to skin around the stoma. Ointments will not allow the pouch to stick on the skin.
· Do Not use a heat lamp or hair dryer to “dry” a rash. This can burn the stoma and the baby.
CALL THE DOCTOR IF….
1. Bleeding from inside or outside the stoma occurs.
2. Stoma sticks out of belly 1 inch more than usual.
3. Stoma sinks into baby’s belly (gets lower than skin level).
4. Blisters, rashes, weepy skin are not better in 1 week.
5. BM is different than usual—bloody, smells bad, color change, or different amount of BM.
6. Soft spot on baby’s head is sunken, or he has dark circles around his eyes.
7. Baby acts different than usual: will not feed, is not as active.
8. Baby’s belly is swollen or hurts when it is touched.
9. The stoma turns blue or purple and does not return to its normal pink color in a few minutes.
HELPFUL HINTS
GENERAL
1. Carry extra supplies in your diaper bag to change your baby.
2. Your baby can be bathed with pouch on or off. Bath water will not get into the stoma. Do not use soap that contains cold cream, oils or lanolin. Dial™ soap is a good suggestion. HOWEVER, do not wash skin around the stoma with Dial™ soap.
3. Sleepers or overalls that snap at the neck and bottom stop your baby from pulling off the pouch.
4. Tuck the pouch in the diaper and pin the diaper to the undershirt to prevent your baby from pulling on the pouch.
5. Gas builds up in the bag. Open it to let the gas out, this will prevent odor and/or leakage from occurring. Do Not make a pinhole in the pouch.
6. Empty the bag when it is 1/3 full.
7. Do not keep supplies in the car or places where heat can damage them.
8. Some over the counter cleansers, like diaper wipes, have too much lanolin in them, this can cause the pouch not to stick—Please DO NOT use them.
FEEDING
1. You will be told how much to feed your baby. The doctor will tell you when to increase the baby’s feedings.
2. Increasing the feeding too fast may give your baby diarrhea.
3. Some babies go home on formula that is easier to digest or that does not have sugar in it.
4. Neocate®(a special type formula), MCT Oil, cereal, and/or high-calorie baby formula may be used to give your baby calories needed for growth without giving him too much liquid.
CARE
1. It is a lot of work taking care of a baby with an ostomy.
2. We suggest that several family members learn the baby’s care so everyone can get some rest or go out.
3. Often it is hard to find people to baby-sit. They are afraid they will hurt your baby or not know what to do. It is important to teach several family member or friends to help so you can get out.
PLAY
1. You do not need to limit your baby’s play.
2. Your baby can lay on his tummy and the pouch.
DOCTOR VISITS
1. As your baby’s health gets better, the visits to the “Specialist” become less often but it is still important to keep your scheduled appointments.
2. Take your baby to a local baby doctor for routine baby care and shots. Make an appointment to see him the first week your baby is home.
3. You will be given all appointments before going home.
Reviewed/Revised:
1/97, 8/98, 7/01, 3/03, 1/06, 5/07, 12/09
SELF-HELP AGENCIES
The United Ostomy Association of America (UOAA)
PO Box 66
Fairview, TN 37062-0066
1-800-826-8826
Greater Fayetteville Ostomy Chapter
Fayetteville, NC
Bobby M. Sullivan
(910) 485-4756
“These Special Children”
Consumer Information
Medical Library: Cape Fear Valley Medical Center
(910) 615-8100
“Tommy & His Ostomy” (Booklet)
Ellen Shipes, RN, MN, ET
International Urological Services
PO Box 408
Long Valley, NJ 07853
“The Sneetchers and Other Stories” (Booklet)
Dr. Seuss