COLOSTOMY IRRIGATION

By. Haryanto, S.Kep,Ns,WOCN


INTRODUCTION
The word ?colostomy? comes from two Greek words. colon is the original Greek word meaning ?large intestine.? It became the English word for colon. Stoma, in Greek, means ?mouth or opening.? A colostomy is ?a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, ?(1), leaving the patient with an opening on the abdomen called a stoma. (1-2) This provides a new path for waste material and gas to leave the body after part of the colon or rectum is removed because of disease or injury. A colostomy may be any where in the colon. It can do to ascending, transverse, descending and sigmoid. With the increase quantity patient with colostomy, irrigation should be considered as a management alternatif for help improve quality of life, especially to permanent colostomy. Patient with colostomy (ostomies) is not obstructed for activities because they can do colostomy irrigation activities before. They can do it with assisted by ET nurse or patient with independently.

COLOSTOMY IRRIGATION
Colostomy irrigation is ? a way to regulate the intestinal activity of colostomized patients, followed by emptying the colon (2-4) done in stoma,(2-4) scheduled at time,(2-4) in which a specified volume of liquid, usually water at body temperature. (2)
The first colostomy irrigation was introduced by duret over two hundred years ago. (2) In Indonesia did not yet founded when colostomy irrigation did.




PURPOSE
Physiologically, the introduction of a volume of water in the colon causes a structural dilation, which stimulates contraction, thus promoting the emptying of the fecal content. It reduces the formation of gas since, by removing the residues, the bacterial microbiota is reduced quantitatively, and consequently the production of gases is also reduced. (3). Besides, it can maintain normal bowel function(5) and also can help avoid constipation.(3)

CANDIDATE AND TIME FOR COLOSTOMY IRRIGATION
Colostomy irrigation can do to patients have a descending or sigmoid colostomy, because their stools tend to be more formed,(3,8) a history of regular bowel perform the procedure, the ability (manual dexterity and visual acuity) to perform procedure, a lifestyle that is compatible to irrigation (work schedule, bathroom facilities, adequate time, other family or personal issue. (5,8) Patient with a urostomy, ileostomy, asending colon cannot do irrigation, (4) and in case rare, transverse colostomies can irrigate but results are generally too poor to justify the effort.
Colostomy irrigation is most effective when it is done about one hour after a meal, when the colon is most likely to be full. Irrigation may be done once a day or once every other day depending on your patient preference and ability to regulate bowel movements. It generally takes about six to eight weeks(3) or two weeks to six months(2) for the bowel to become regulated with irrigation. It is important to establish a routine and irrigate at the same time each day.(5)

CONTRAINDICATION
Contraindication do colostomy irrigation includes people with irritable bowel syndrome, stomas in the ascending or transverse colons are less likely to have success with irrigation, (3) stomal prolapse or peristomal hernia because the procedur could potentially exacerbate or cause bowel perforation, leakage between irrigation. Chemoteraphy, pelvic radiation, a poor diagnosis, and diarrhea are also contraindication colostomy irrigation.(5,8)

THE TIME OF SPENT AND THE VOLUME OF LIQUID OF COLOSTOMY IRRIGATION
The time spent the procedure was from 33 minute to 90 minute.(2) The volume of liquid infused varied from 500mls to 1500mls.(2)

COLOSTOMY IRRIGATION PROCEDURE

Equipment
A trolley [which is cleansed with an appropriate solution] with the following:
01. Irrigation container
02. Irrigation fluid 500 to 1,000 ml lukewarm water or other solution
03. Soft rubber catheter No. 22 or No. 24
04. New colostomy appliance
05. Irrigation sleeve
06. Disposable gloves
07. Apron
08. Lubricant
09. Receiver / plastic bag for the disposal of old colostomy pouch / dressing
10. Cotton wool swabs
11. Protector / plastic sheet [if patient is confined to bed]
12. Bedpan





Figure 1.

Procedure
01. Verify physician?s order, progress notes, and nursing care plan for colostomy.
Rationale: to obtain specific instructions and / or information.
02. Assess patient?s condition to determine if procedure should be done in bed or
in the bathroom.
03. Ensure privacy. Rationale: to avoid unnecessary embarrassment to the
patient during the procedure. Respect for patient's privacy is an essential
aspect of the holistic care of a patient.
04. Wash hands and dry hands.(refer Hand washing procedure). Rationale: to
reduce nosocomial infection.
05. Don gloves.
06. Assemble equipment correctly. Rationale: it ensures the procedure is carried
out smoothly.
07. Explain procedure to patient. Rationale: to allay fears and gain patient's
confidence and cooperation.
08. Position patient. Lie patient on the side closest to the stoma or in supine
position if patient is confined to bed. Sit the patient on toilet if ambulatoy.
09. Remove regular ostomy pouch by unsnapping the pouch from the skin barrier
with flange. Rationale: proper disposal of the colostomy to avoid
contamination.
10. Cleanse stoma and surrounding skin area. Rationale: it promotes comfort
and hygiene.
11. Apply irrigator sleeve by snapping it onto the skin barrier with flange. (Figure
2)
12. Connect irrigation bag to tubing. The two pieces slide apart and push
together. If stoma protrudes, use the cone tip.
13. Put on glove, lubricate small finger and gently insert into colostomy to
determine the direction of the lumen.
14. Fill irrigating bag with 1000 mL lukewarm water. If new ostomy, begin with
250 mL lukewarm water, or as ordered by physician.
15. Hang bag so that bottom of bag is at patient?s shoulder level, (Figure 3) or if
patient is on bed rest, 18 inches ( 45 cm ) above stoma. Rationale: it ensures
the irrigation fluid will flow by gravity.
16.Allow small amount of water to run through tubing to clear it of air. Rationale:
air will not be introduced into the colon that could cause discomfort to the
patient.




17.If using a catheter, lubricate and gently insert about two inches. Rationale:
ensures a smooth entry into the stoma and avoids friction. If any resistance is
felt, change direction of catheter and/or allow small amount of water to flow
through catheter before attempting to insert it further.
DO NOT FORCE CATHETER.
18.If using cone tip, hold snugly into stoma.
19.Open clamp and allow water to enter bowl. Patient may complain of cramping
if irrigation flows too rapidly. If cramping occurs, clamp off tubing until cramps
subside.
20. Remove catheter and fold over top of drain sleeve and fasten closed with
clamp provided to prevent return from splashing.
21. Allow about 15-20 minutes for most of drainage to return, then rinse sleeve
with lukewarm water through top of sleeve.
22. Fold end of irrigating sleeve up twice and clip to top, thus making a
temporary catch bag. Patient may now go out into room for remaining 45
minutes. (Allow 1 hour for complete return). Note color and amount of
drainage. Observe stoma for color.
23. After 1-hour, rinse irrigating sleeve and remove by unsnapping it from skin
barrier with flange.
24. Apply clean pouch by snapping it onto skin barrier with flange.
May apply Banish deodorant into pouch.
25. Wash and dry hands. Rationale: to reduce the risk of nosocomial infection.
26. Wash irrigating equipment and allow to dry. Place patient?s name and room
number on a piece of tape and attach to equipment hanging in the bathroom.
Rationale: the clean equipment will be ready for re-use.


27. Complete Documentation (type and amount of irrigant,whether cone tip or
cath use, description of stoma, amount and type of returns, If wafer and pouch changed, description of peristomal skin). Rationale: to determine skin
/ stoma integrity and to detect early signs of infection and any possible problems.


CONCLUSION

Colostomy irrigation is a methode that purpose to waste stool in large intestine. Even thoungh colostomy irrigation is not required to maintain bowel function, the procedure is a management option that may allow a patient to be free from fecal discharge. The most important factors before to irrigate, ET nurse (ETN) have to know patient?s clinical situation and life style. Irrigation is more effective for patient have a descending or sigmoid colostomy, because their stools tend to be more formed. Colostomy irrigation is most effective when it is done about one hour after a meal, Patient and family are explained about advantage and purpose before colostomy irrigation do. So that patient can be active to regulate do. ET nurse have to know principal irrigation, so that can do irrigation truly. After The colostomy irrigation, patient and family can do it them self in house. So ostometies will maintain their quality of life.



REFERENCES

1. Http://en.wikipedia.org/wiki/colostomy.com colostomy (cited; November, 2008)

2. Cesaretti R, Colostomy irrigation: review of a number of technical aspect.
APE (serial on the internet). 2008 Feb 9; (citied; 2008 Oktober 29); 21 (2): (about 8 screens). Available from: http://www.scielo.br/scielo.php.com

3. Haines, CD. Editor Haines, CD. Digestive deases: colostomy irrigation (homepage on the internet). Webmed, Inc. (update 2006 March 01; cited: 2008 Oktober 18).Available from: http://www.webmed.com/colorectal-ancer/colostomy-irrigation

4. United Ostomy Association of Canada. A handbook for new ostomy patients
(monograph on the internet). Canada: Second printing; 2007 (cited 2008 Oct 17) Available from: http://www.ostomy.evansville.net

5. Turnbull, GB. A look at purpose and outcome of colostomy irrigation. OWM
(serial on the internet). 2003 Feb 01; (cited 2008 Oct 28); 49 (2): (about 2 screens) Available from: http://www.O_WM.Com/article/1257


6. Turnbull, GB. Managing oversight of colostomy irrigation in long term-care.
OWM ( serial on the internet). 2003 Oct 01; (cited 2008 Oct 28) 49 (10): (about 2 screens) Available from: http://www.O_WM.Com/article/1258

7. Blackley, P. Practical stoma wound and continence management.
2nd ed. Research publication Pty Ltd Vermont, Victoria, Australia; 2004

8. Turnbull, GB. An alternative solution for difficult to manage colostomies in the
descending and sigmoid colon. OWM (serial on the internet). 2007 Agt 01 (cited 2008 Oct 28) 53 (8): (about 2 screens) Available from:http://www.O_WM.Com/article/1259

9. Shorehealth (homepage on the Internet). Colostomy Irrigation (uptade 2008 January; cited 2008 Nov 01) Available from : http://doctors.shorehealth.org/nursing/pdf/colostomy%20irrigation.pdf

10. Horn, CV. Having a colostomy: a primer for the colostomy patient (monograph on the internet). Ohio: The department of grapich service; 1992 (cited 2008 Nov 01). Available from: http://my.clevelandclinic.org/Document/digestive disease/havingcolostomy.pdf






























COLOSTOMY IRRIGATION











HARYANTO








INDONESIAN ENTEROSTOMAL THERAPY NURSING EDUCATION PROGRAMME
2nd 2008









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