What Is a Colostomy/ Ileostomy?

Your Colostomy/Ileostomy 1 5/23/2016 5:42:25 PM

Surgical Patient Education Patient Surgical

SAMPLE mouth) your of inside the to Be red moist and (similar no feeling Have Stick out of the body, usually an inch or less above the skin the above or less inch an usually out body, the of Stick Vary size in shape in Be or round oval Ostomies that discharge stool are ileostomies called colostomies. or Be slightly swollen for first the weeksBe slightly after the permanent their operation size to then and shrink f f f f f f f f f f f f f f Your stoma is the end the stoma is Your or large small the of can be that seen intestine protruding or sticking out of the abdominal site new the is It wall. the where stool leave will body be and collected pouch. The ostomy the in and size on depends stoma the of location specificyour abdomen.operationyour shapetheand of An ostomy is a surgically is An ostomy created opening in the discharge abdomen the for of body waste. After the ostomy will you created, is waste expel release or stoma. a through Ileostomy? Most stomas are similar and will: What Is a Colostomy/ Is What 2016 Ostomy Skills Kit Booklet_v5.indd 1 2 3

Who Needs an Ostomy? Disease or injury such as cancer, trauma, inflammatory bowel disease, or certain birth defects can block the flow and drainage of stool. If the segment of the intestine cannot be repaired, then your surgeon will perform ostomy operation. The ostomy will reroute the stool to a new opening on the abdomen.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 2 5/23/2016 5:42:27 PM Your Colostomy/Ileostomy 3 5/23/2016 5:42:27 PM Sigmoid Colon Large Intestine/Colon Large Stomach Rectum

Surgical Patient Education Patient Surgical Anus Esophagus SAMPLE Ileum Food passes from your mouth through your esophagus esophagus your through mouth your from passes Food The stomach. breaks your stomach to food down into intestine. small the into move pieces that small enzymes intestine, small the In a thick food down break into The Theliquid. body absorbs nutrients, water. vitamins, and called also colon. the intestine, large the into moves material absorbed is water colon, from the In stool. the becomes It parts the through it moves as colon. the Your of thicker rectum the stool expelled from passes into colon the is and operation bring either will the Your anus. the through surface the to abdomen. the of intestine or large small Small Intestine Colostomy Operation Colostomy Understanding Your Digestive System Understanding Your Your Your Ileostomy/ 2016 Ostomy Skills Kit Booklet_v5.indd 3 2 4 5

Ileostomy An ileostomy is the opening created by the surgeon to bring the small intestine (ileum) to the surface of the abdomen. An ileostomy may be temporary or permanent.

Colostomy A colostomy is the opening created by the surgeon to bring the colon (large intestine) to the surface of the abdomen. There are various kinds of colostomies, each named for the location in the colon where the ostomy is formed. They are: ascending, transverse, descending, or sigmoid colostomy. A colostomy may be temporary or permanent.

Ileostomy/Colostomy Output The stool that comes out of your stoma will be liquid after the operation. It will get thicker within several days. Stool that drains from an ileostomy is more liquid. Ileostomies are created higher in the intestine, and less water is absorbed from stool. The stool draining from a colostomy is more formed. If your rectum and part of your colon have not been removed surgically, it is common to have mucous discharge from your anus. Sometimes the mucous becomes firm enough to look like stool. This type of anal discharge is not a cause for concern.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 4 5/23/2016 5:42:28 PM Your Colostomy/Ileostomy 5 5/23/2016 5:42:28 PM

Surgical Patient Education Patient Surgical SAMPLE Protects skin the stoma the around Collects Collects stool odor the Contains f f f f f f Your stool exit will from opening a new called a stoma and Your be feel able won’t to or bewill collected a pouch. in You body your stoma, the through stool it leaves your as control pouching system. ostomy need an will so you wear to The pouching system sticks the or adheres to skin stoma. the around The pouch: Stool on the stoma will not cause any problems, but stool any cause on not the on stoma the will Stool get skin the stoma can the cause redskin to or surrounding irritated. flat lie and pouching lightweight systems are Ostomy different in systems come Pouching body. the against doctor styles. and sizes nurse or a WOC can help you Your best onechoose is which Most for you. people try several types pouches of before choose they one permanently. About the Pouch About the Pouch 2016 Ostomy Skills Kit Booklet_v5.indd 5 4 6 7 Pouching System/Types Pouch systems are made up the skin barrier that holds the pouch to the skin and the pouch that collects the drainage. They are available as a one-piece or a two-piece system.

ONE-PIECE SYSTEM Skin In a one-piece pouch, the pouch and barrier skin barrier are attached together.

Pouch

TWO-PIECE SYSTEM

In a two-piece system, there is a skin Skin barrier and a separate attachable pouch. barrier The skin barrier adheres to the skin around the stoma and protects the skin, giving you a place to attach the pouch. The skin barrier usually includes a flange or rim that is used to seal the pouch to the skin barrier. Flange sizes are made to fit exactly to a specific pouch. The flange may make the system less flexible. However, you may find it convenient to be able to change your Pouch pouch more frequently without having to remove the skin barrier each time.

DRAINABLE POUCH

A drainable or open pouch can be opened at the bottom to expel waste. You do not need to remove a drainable pouch to empty. The pouch can remain in place for several days. Drainable pouches are easy to empty and are an option for people with ostomies that need to be emptied several times a day.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 6 5/23/2016 5:42:29 PM Your Colostomy/Ileostomy 7 5/23/2016 5:42:30 PM

Surgical Patient Education Patient Surgical When the pouch does not have to beWhen to emptied often pouch the does have not traveling while convenience For moments, because less During intimate it is bulky or closures no clips has and While swimming SAMPLE f f f f f f f f A closed-end pouch has no opening and closed-endA and opening no has pouch becan’t emptied. When pouch the you full, is several use could you Since it away. throw need will you carry to extras.pouches day, a need the also will place bags to plastic You full pouch trash. the it in before in throwing closed-end suitable A not generally is pouch because ileostomy for an patients with of needthe frequently empty to pouch. the one- in two-piece or Closed-end available are pouches systems. closed-endA often is pouch used: CLOSED-END POUCH 2016 Ostomy Skills Kit Booklet_v5.indd 7 6 8 9 Pouch Closure

ILEOSTOMY AND COLOSTOMY

A clip or roll-up-and-seal method is used to close a pouch for a colostomy or ileostomy. The pouch is sealed by folding or rolling the opening, usually three times in the same direction. Then, either press across the opening or use Velcro® tabs that secure around the closure.

CLAMP METHOD

When using a clamp, be sure to wrap the end or tail piece around the clamp, and tug on the clamp once while holding the bag to make sure it doesn’t slip off. Clamps usually last a month or longer.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 8 5/23/2016 5:42:35 PM Your Colostomy/Ileostomy 9 5/23/2016 5:42:36 PM Filter

Surgical Patient Education Patient Surgical SAMPLE Some pouches have small vents, called vents, small Some pouches have escape.to gas The allow that filters, deodorizes out. it filters vent as gas once well typically work not do Filters getthey wet. or bathe So swim, if you opening the cover to have may you or tape. waterproof a cover with Pouches can be Pouches orsmall large. The you size need depends of on amount the output you that produce as well personal your as preference. An ileostomy watery produces output and needs be to be pouch so a larger needed. may emptied about a day, 5 times more formed. output is A personColostomy a colostomy with so a shorter pouch often may may 1 or 2 stools per produce day, visible less and smaller is It work. available. pouch also A mini is beto changedunder or has clothes. emptied It more often. intimacy during exercise. and The pouch convenient mini is Some pouches are clear or transparent, and others are opaque your hospital, the While in see them). can’t (you through When getpouch be you or most transparent. will clear likely opaque an pouch. to switch prefer to may home, you Pouch withPouch Filter Pouch Sizes Pouch Pouch Colors 2016 Ostomy Skills Kit Booklet_v5.indd 9 8 10 11 11 Pouch Belts and Wraps Some people wear an ostomy belt or wrap around their abdomen. The belt provides extra support. Some pouch belts/wraps are made specifically for water sports. If you choose to wear an ostomy belt or wrap:

ff Attach a belt so that it lies evenly against your abdomen and lies level with the pouching system.

ff The belt/wrap should not be so tight that it cuts into or leaves a deep groove in your skin.

ff You should be able to place one finger between the belt and your abdomen.

ABOVE PHOTO: STEALTH BELT INC.

Pouch Covers Pouch covers are lightweight, soft coverings that go over the pouch. They come in a variety of colors and prints. The coverings may decrease any uneasiness associated with having someone view the pouch. They may also reduce heat and moisture caused by the pouch resting against the skin.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 10 5/23/2016 5:42:38 PM Your Urostomy 11 5/23/2016 5:42:38 PM 11

Surgical Patient Education Patient Surgical Stick out of the body, out body, the of Stick skin the above or less inch an usually Vary size in shape in Be or round oval mouth) your of inside the to Be red moist and (similar no feeling Have swollen for first the weeksBe slightly after the operation permanent their size to thenand shrink SAMPLE f f f f f f f f f f f f An ostomy is a surgically is An created ostomy abdomen the for in opening body of An discharge the waste. ostomy that discharges urine is After ostomy the a urostomy. expel will you created, or is stoma. a through urine release end the small the of stoma is Your or large intestine that can be out sticking or seen protruding the abdominal the is of It wall. where leave urine will site new bodythe be and collected in pouch. The ostomy the and size depends stoma the of location and operation specific your on the shape of abdomen. your Most stomas are similar will: and What Is a Urostomy? a Urostomy? Is What 2016 Ostomy Skills Kit Booklet_v5.indd 11 10 12 13 Your Urostomy Operation

Understanding Your Urinary System Your urinary system includes two kidneys, two ureters, a bladder, and a urethra. The kidneys make urine by filtering water and waste products from your bloodstream. The urine Kidney drains from the kidneys, through the ureters, and empties into the Ureter bladder. The bladder stores the urine. Urine is expelled or comes out when it passes from the bladder through the urethra. The Bladder creation of a urostomy changes how you expel your urine. Urethra

The Operation A urostomy is an operation that reroutes urine to an opening on the surface of the abdomen. A conventional Kidney urostomy operation involves removing a small section of the ileum (small intestine). Stoma The intestine is reconnected Ureters so that it functions normally. Ileal Conduit The surgeon uses the small piece of that ileum that is Bladder removed to make a detour for urine, called an ileal conduit. One end of the piece is sewn closed and the other end is brought to the surface of the abdomen to form a stoma. The ureters are removed from the bladder and attached to the new ileal conduit. Urine now flows from the kidneys, through the ureters, out the ileal stoma, and into the collection pouch. Your surgeon can also perform the operation using a section of the colon (large intestine), which is called a colon conduit.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 12 5/23/2016 5:42:38 PM Your Urostomy 13 5/23/2016 5:42:39 PM Stent

Surgical Patient Education Patient Surgical Contains the odor the Contains Protects skin the stoma the around SAMPLE

Collects urine f f f f f f Urine on the stoma will not cause any problems. on Urine skin the any cause not onUrine stoma will the get skin the stoma the can cause red to orsurrounding irritated. against flat lie and pouching lightweight systems are Ostomy and sizes different in systems come Pouching body. the or a certified you nurse, can help doctor, ostomy styles. Your best people onechoose is which Many for you. try several types pouches of before choose they one permanently. Your urine will now exit now urine will from opening a new called a stoma and Your be feel able won’t to or control be collected a pouch. in You body your stoma, the so you through it leaves urine as your pouching times. system all at ostomy need an will wear to The pouching system sticks the or adheres to skin stoma. the around The pouch: Due to postoperative swelling, you may have small temporary small have may Due postoperative you swelling, to tubes called stents extending are stoma. Stents out your of help and ureters the themplaced up keep open. allows This stoma. the They out through be drain will urine to removed decreases. surgeon or swelling the nurse your once by Urine will start flowingyour ostomy into may It operation. after your right pouch beforebe or pink red for days a few color. yellow normal the to returning through Because passing urine the is the and a segment intestine the of intestine produces mucus, you may see urine. your some in mucus Aboutthe Pouch Urostomy Stents Urostomy Urostomy Output Urostomy 2016 Ostomy Skills Kit Booklet_v5.indd 13 12 14 15

Pouching System/Types Pouch systems are made of the skin barrier that holds the pouch to the skin and the pouch that collects the drainage. They are available as a one-piece or a two-piece system.

ONE-PIECE SYSTEM

In a one-piece pouch, the pouch and skin barrier are attached together.

TWO-PIECE SYSTEM

In a two-piece system, there is a skin barrier and a separate attachable pouch. The skin barrier adheres to the skin around the stoma and protects the skin, giving you a place to attach the pouch. The skin barrier usually includes a flange or rim that is used to seal the pouch to the skin barrier. Flange sizes are made to fit exactly to a specific pouch.

UROSTOMY POUCH

All urostomy pouches are drainable and have a special valve inside the pouch that prevents the urine from backing up around the stoma. The drain expels urine at the bottom of the pouch. The drain can be a tap that turns to open or close, or a drainage nozzle that has a plug.

Many pouch taps have a colored marking to indicate when the pouch is open. The mark cannot be seen when the tap is closed. You do not need to remove the drainable pouch to empty it. It can remain in place for several days.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 14 5/23/2016 5:42:39 PM Your Urostomy 15 5/23/2016 5:42:41 PM

Surgical Patient Education Patient Surgical SAMPLE Pouches can be small or large. The size you need The you can or be large. size small dependsPouches on amount the personal your A as well preference. as produce, you outputof that output needs and liquid be produces to emptied about urostomy five be pouch so a larger needed. may Other types a day, times pouches of for specific available needs. also useare a you wheelchair andhave If trouble emptying to frequently night up at a pouch, wake or if you pouch a mini connectedempty wear choose to pouch, may your you bag. a urinary a drainage Duringto intimacy exercise, and stoma cap option—which pouch an a mini filledabsorbentis is with material. Some pouches are clear or transparent, and others are opaque the hospital, the While in see them). can’t (you through When go pouch be you or most transparent. will clear likely opaque an pouch. to switch prefer to may home, you Pouch Sizes Pouch Color 2016 Ostomy Skills Kit Booklet_v5.indd 15 14 16 17 Pouch Belts and Wraps Some people wear an ostomy belt or wrap around their abdomen. The belt/wrap provides extra support. Some pouch belts are made specifically for water sports. If you choose to wear an ostomy belt:

ff Attach the belt so that it lies evenly against your abdomen and lies level with the pouching system.

ff The belt/wrap should not be so tight that it cuts into or leaves a deep groove in your skin.

ff You should be able to place one finger between the belt and your abdomen.

ABOVE PHOTO: STEALTH BELT INC.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 16 5/23/2016 5:42:42 PM Your Urostomy 17 5/23/2016 5:42:44 PM Pouch Adapter

Surgical Patient Education Patient Surgical Place the adapter on nighttime the bag adapter the drainage Place Connect end the pouch the connector the of to bag drainage the on tubing long the on Open pouch the tap SAMPLE Empty urine the from the toilet the bagdrainage into be instructed may drainage the rinse to You water or water bag with and vinegar decrease to Other bag-cleaning odor. products be suggested may nurse or doctor your by Unravel and free and long the Unravel tubing from kinks any Drainage bags can be freestanding bedor your of hooked side the to Remove the drainage bag pouch the from tubing pouch the Close f f f f f f f f f f f f f f f f f f All urostomy pouches come with adapters that can be pouches that attached adapters with come urostomy a All to sleeping. are empty pouch you the while keeps bag. This drainage larger Connecting the to drainage bag: During the day, you will need to drain your urostomy urostomy need will your you drain to During day, the pouch about every hours 4 large a 2 to drink or more if you your doctor you not Unless fluids. nursetells of or amount day. each water of glasses 10 8 to drink should you to, Disconnecting and emptying the drainage bag: emptying and drainage the Disconnecting Nighttime Drainage Daily Care 2016 Ostomy Skills Kit Booklet_v5.indd 17 16 18 19 19

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 18 5/23/2016 5:42:47 PM Ostomy Skills: Emptying and changing the pouch 19 5/23/2016 5:42:47 PM 19

Surgical Patient Education Patient Surgical SAMPLE For the forward the For far position, wide. legs with sit back on spread seat the backwards the For or stand position, sit facing toilet. the or stand position, sit side the toilet. the For alongside Emptying youneed pouch will first the to your learn skill is that after operation most use your will one the often. and you steps. the of each then and follow DVD, the Watch f f f f f f f f f f You will need to have a clear view of the water in your toilet and and toilet your in view water the of a clear need will have to You empty to enough space pouch your avoid and have you ensure on depending positions, several There are clothes. your soiling comfort bathroom, the your and of level. layout the size, your Empty or change your pouch when it is 1/3 Empty pouch your 1/3 when or change it is start full may too full. is A pouch that 1/2 to feel not will skin. from your You away pull to stoma. You urine or out stool your of coming need will placing check by for fullness to pouch your feeling and it. over hand your Empty the Pouch SKILL Pouch the Empty SK ILL: A SSUME POSITION PROPER THE SKILL: CHECK THE POUCH LEVEL Watch andWatch Review 2016 Ostomy Skills Kit Booklet_v5.indd 19 18 20 21

SKILL: EMPTY THE URINE (UROSTOMY ONLY)

Sit far back on the seat or stand over the toilet.

1. Raise the pouch opening. 2. Open the pouch by twisting the nozzle, removing the nozzle plug, or folding down the nozzle. zz Before lowering, pinch together the nozzle. zz Lower the nozzle toward the toilet. zz Release your pinched fingers and let the urine drain. zz When empty, tap the nozzle to remove any last drops.

3. Close the pouch by twisting the nozzle into the closed position, replacing the nozzle plug, or folding up the nozzle.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 20 5/23/2016 5:42:48 PM Ostomy Skills: Emptying and changing the pouch 21 5/23/2016 5:42:50 PM

Surgical Patient Education Patient Surgical SAMPLE Raise the pouch the Raise so opening the up. faces or unclamp will Open pouch. the You unroll the integrated drainage outlet. Make sure to have a piece of a piece of have to sure Make papertoilet reach. within Reclamp or reseal the pouch. Wipeand opening the inside off paperout toilet with or tissue. deodorant. pouch add If used, Lower the opening into the toilet. Slide your your Slide toilet. the opening the into Lower out stool. the pouch the down push hands to standIf you emptying while pouch,the you drain you as toilet the flush to want may pouchthe toilet pieces of a few or place bowl. prevents toilet the This paper into from stool splashing the water toilet and from when distance. up a high draining

2. 3. Sit far toilet the or back on standSit seat the over 1. 8. 6. 7. 4. 5. SKILL: EMPTY THE STOOL SKILL: EMPTY THE STOOL (COLOSTOMY/ILEOSTOMY ONLY) 2016 Ostomy Skills Kit Booklet_v5.indd 21 20 22 23 Change the Pouch SKILL

Watch and Review ff Your entire one-piece pouch will need to be changed every 3 to 5 days. Moisture and sweat, a full and heavy pouch, and uneven skin around the stoma can decrease the length of time the system will stick to the skin. If you see any output or leakage, or if you feel any burning or itching under the barrier, change your pouch right away.

ff If you have an ileostomy or colostomy, it is easier to change the pouch when the stoma is less active. Ideal times include first thing in the morning before eating or two hours after eating.

ff If you have a urostomy, you will always be producing urine, so the pouch and barrier can be changed any time.

ff Watch the DVD, and then follow each of the steps.

SKILL: GATHER YOUR SUPPLIES

ff New pouch

ff Washcloth/wipes/soft paper towels to clean your skin

ff Sizing template to measure your stoma and size the opening

ff Pen to trace the size of your stoma

ff Scissors to cut the opening

ff A small plastic bag for the soiled pouch

ff Skin barrier paste (optional) to fill uneven areas in the skin

ff Skin barrier powder (optional) to absorb the moisture from weepy skin

ff Pouch deodorant (optional) to decrease the odor when emptying the pouch

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 22 5/23/2016 5:42:51 PM Ostomy Skills: Emptying and changing the pouch 23 5/23/2016 5:42:52 PM

Surgical Patient Education Patient Surgical Soaps/cleansers with oil or perfumes oil with Soaps/cleansers or alcohol cream, moisturizing oil, have wipesBaby that SAMPLE z z z z Place the old the pouch bag. waste plastic a in Place Begin by peeling away one corner of the barrier. one Begin barrier. the of peeling corner by away down pushing rest the barrier, the of around Work same the at point while time on skin the each at from skin. the barrier the Somepulling away a piece wet of people remover, adhesive use to warm with water or a washcloth paper towel, pouch the barrierhelp remove from skin. the Gently pat the skin dry. Gently skin the pat dry. can apply you a small irritatedIf or skin the weepy, stoma the is around The absorb moisture. the powder will skin of barrierdusting powder. Remember moist. skin if is your barrier new the well stick not will that prep. powder the skin with need sealant/skin or spray dab may to You Clean the skin the warm stoma the with around Clean skin barrier your keep from may sticking. Oils Do use: not water. Inspect your stoma for color. The Inspect stoma for color. your bestoma should red moist. and Inspect skin the for redness or irritation. The skin rest the skin the of look should like mirror a can use abdomen.on your You check skin the stoma. the to around If your pouch has a closure clip, do not throw do throw not clip, pouch closure a If your has The can be trash. the it in clamp reused.

3. 1. 2. 4. 5. 3. 1. 2. 4. SKILL: CLEAN AND INSPECT SKILL: REMOVE SKILL: THE OLD POUCH 2016 Ostomy Skills Kit Booklet_v5.indd 23 22 24 25

SKILL: MEASURE AND CUT THE OPENING

It is important to measure the stoma and make sure the opening of the barrier fits right to the edge of the stoma. For the first three months after your surgery, your stoma will continue to shrink in size as your swelling goes down. In the beginning, you will have to measure your stoma with each pouch change to make sure you have the right size opening. After that, you will be able to pre-cut your pouch opening from your template, or order pre-cut pouches.

1. Cover the stoma opening. Place a piece of tissue or gauze pad over the stoma while you are measuring to catch any leakage. 2. Measure the stoma. Use your measuring grid and find the size that fits close to the edge of the stoma where the skin and stoma meet. If your stoma isn’t round, your WOC nurse or doctor can make you a custom template. 3. Place the measuring grid on the back of the pouch barrier and trace the correct size. 4. Use scissors to cut an opening in the skin barrier, closely following the traced shape. If you are using a one-piece system, place your finger into the small pre- cut opening and push away the pouch before you start to cut. Be careful not to cut through the front of the pouch. If you cut the pouch, do not tape it closed. It will leak and give off an odor. 5. Center the new opening over the stoma to make sure it fits along the stoma edge. Re-cut and adjust the opening as needed.

To practice:

ff Gather your supplies in the skills kit. ff Use the stoma practice model, measuring guide, and pouch to: zz Measure and cut an opening. zz Apply a new pouch to the model.

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 24 5/23/2016 5:42:53 PM Ostomy Skills: Emptying and changing the pouch 25 5/23/2016 5:42:55 PM

Surgical Patient Education Patient Surgical SAMPLE Empty pouch the sitting on or standing toilet. the by Take out your sample pouch. sample your out Take at opening drainage the Close bottomthe pouch. the of opening top skin the the in At 1/3 water. with full it fill barrier, paper the Remove backing and pouch the skinplace on your abdomen. lower your on Close the opening if you are opening the Close are if you ausing drainable pouch. pouch. the Lower a belt use If secure you your to place. it in pouch, clip paper the keep and backingDate for template your as use to nextthe pouch change. Place the barrier the on skin the around Place sides on down all stoma.the Press 60 seconds, to startingfor 30 at stoma. your nearest to area the firmlyapplied. is it sure Make Remove the covering from the the from covering the Remove skinback the of barrier. opening cut the the in Center stoma. the over barrier pouch’s f f f f f f f f f f

4. 5. 6. 7. 3. 1. 2. SKILL: APPLY THE NEW POUCH THE NEW POUCH APPLY SKILL: To practice: To 2016 Ostomy Skills Kit Booklet_v5.indd 25 24 26 27 Stoma Supplies Keep your stoma care simple. Only use paste, powder, prep, or seals if recommended by your doctor or WOC nurse.

SKIN BARRIER PASTE/RINGS

Skin barrier paste or rings are used to fill body folds or uneven areas around the stoma. It can help create a better seal between the skin and the skin barrier.

How to Apply Apply the paste to skin folds in a single layer. If you have deep skin folds, you may have to apply the paste in layers, letting each layer dry slightly (about a minute) before applying the next layer. Pastes are sometimes placed directly onto the barrier.

Pastes should not irritate your skin. If you develop a reaction to any type of paste, then try another brand. Most tube pastes are alcohol-based, and they can sting your skin if they are placed on open skin. The stinging should stop within a few seconds as the paste dries. Alcohol-free paste is also available.

Skin Barrier Rings A barrier ring may also be used to fill gaps where the pouch skin barrier may leak. Barrier rings are easy to work with and contain no alcohol. While they can be cut or molded into any shape, the more they are touched, the less sticky they become.

SKIN BARRIER POWDER

Skin barrier powder is used to help protect and dry raw, weepy areas on the skin. It is placed under the skin barrier on the skin around the stoma.

How to Apply Clean your skin with water, then pat dry. Lightly dust the irritated skin with the powder and brush off the excess. You may have to use skin sealant after the powder in order for the pouching system to stick to the skin. Then apply the pouching system.

American College of Surgeons • Division of Education

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Surgical Patient Education Patient Surgical SAMPLE Adhesive removers are used to remove the skin barrier, tape, and sticky residue. You will tape, sticky and You skin the barrier, residue. remove used are to removers Adhesive before soap with water and applying oily residue pouch. a new any need away wash to The ostomy pouch is odor proof. The pouch odorThe when odor only an is time is proof. be ostomy will noticeable emptyyou form. deodorantpouch. the The spray and drop in comes Pouch deodorant empty the placed in is pouch after decrease odor. to draining/emptying Skin barrier/sealant is a liquid skin barrier. It comes in a spray, wipe, or gel. It a spray, in comes It skin barrier. a liquid is Skin barrier/sealant skin the on skin. the sure Make coating put used a protective to is plastic-like skin. your to system pouching before the applying completely dries barrier ADHESIVE REMOVER ADHESIVE POUCH DEODORANT POUCH SKIN BARRIER/SEALANT 2016 Ostomy Skills Kit Booklet_v5.indd 27 26 28 29 29

American College of Surgeons • Division of Education

2016 Ostomy Skills Kit Booklet_v5.indd 28 5/23/2016 5:42:59 PM Problem Solving 29 5/23/2016 5:43:00 PM 29

Surgical Patient Education Patient Surgical SAMPLE Check your skin with each pouch change. Use a mirror if if a mirror skin Use pouch each with Check your change. needed stoma. see skin the of your to around all the barrier the fit cut stoma and the stoma. to Measure skin the Do 5 barrier wear not 3 to long. too is time Suggested wear can time depend often on how Wear emptydays. you pouch, your body activity, of your and level your sweat, shape. you much how Lightly apply skin barrier powder. If irritated skin the (wet), or weepy is skinuse to have Youmay applythe off powder the brush and excess. Then apply prep after pouching the system.sealant/skin powder. the seepageIf is there stool of skin orskinyour urine underby a a specific of or area needfold, may gaps. you skin barrierany in or paste a moldable fill ring to Don’t delay in asking for help. One visit with a WOC nurse could save you you save nurse asking One a WOC in with for could help. Don’t visit delay error. and trial extensive through going from Measure your stoma during each pouchafter for each first the change stoma during your 3 your months Measure body your best as shape size and is It in heals. change stoma will operation. Your buy pre-cut to not operation. after least 3 months barriers ostomy at your until f f f f f f f f f f f f f f The skin stoma can the become around most the irritated red. and is This most patients. problem often is It common for ostomy new stool to or due urine on skin, the skin. or fromof tape barriers and toplayer the off pulling This image shows skin redness directly image shows This stoma the above barrier the possibly to being not due is This cut site. apply stoma correct the Ifto weepy, skin the is size. look should The site apply. and barrier, the resize powder, better next the with 5 days. pouch 3 to in change irritated red and skin image shows entire the This around sensitivity possibly to due is This or stripping stoma site. when barrier. the removing skin of away layer top the needbe may when to more tape, gentle removing You or try barrier. a different remover, adhesive an use Problem Solving Problem WHAT YOU CAN DO CAN DO YOU WHAT Irritated and Red Skin 2016 Ostomy Skills Kit Booklet_v5.indd 29 28 30 31 Barrier Not Sticking

WHAT YOU CAN DO

If the barrier is not sticking, you may want to try:

ff Cleaning the skin with water. If you use soap or any adhesive removal wipes, rinse the area well with water to make sure there is no residue left on the skin.

ff Make sure the skin is totally dry.

ff Warm the barrier before putting it in place. Some patients find using a hair dryer on low for a few seconds may help.

ff Remove any hair on the skin surface by trimming with scissors or using a safety razor.

ff If you perspire a lot, it may help to use a light dusting of skin barrier powder to absorb perspiration.

ff If you are having trouble getting your barrier to stick or you are using 2 to 3 barriers daily because of leakage, contact your doctor or WOC nurse for additional help.

Signs of Infection Redness around the edges of the stoma while it is healing is normal.

ff If you have redness, tenderness, and pain that extends a 1/2 inch around the incision or stoma, or white/beige fluid draining in the area, call your doctor or WOC nurse.

ff If you have redness, itchiness, and small dots under your barrier without any signs of leakage, you may have a fungal infection. Contact your doctor or WOC nurse for medication to treat the infection.

American College of Surgeons • Division of Education

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Surgical Patient Education Patient Surgical SAMPLE Watch for signs of dehydration. These dry include dehydration. of for signs mouth and Watch going only example, (for output urine low thirsty, feeling tongue, dizziness, or twice amounts or than going less persmall day), days. a few 6 pounds more over of than loss weight doctor your Call oral on solution or what They nurse. you you guide will diet. be Medication your prescribed adjust may to how and that drink should stool of decrease and amount the loss. intestines your down can slow especially are salt and loss dehydration of Risk patient. ileostomy the for concerning Drink at least 8 glasses of water as part as water of routine. regular least 8 glasses Drink your of at an oralor as electrolytebroth such fluids Drink replacement solution. Powerade. and Gatorade, Pedialyte, Examples include empty to pouch. your If have you times many how of track Keep 6 times full more than emptying are you pouch your 1/2 when it is becoming of dehydrated. risk a high at are you per day, Make sure the bleeding the sure stopped has Make after pouch your change. The bleeding minutes. a few stop within should for a minute. apply and pressure a moist can mild use cloth You f f f f f f f f f f f f f f f f You may see a spot blood may of stoma, or especially on when your cleaning You pouch. the changing The a good stoma has blood supply no and longer protection the has skin, so your of a spot blood of normal. is Thebefore stool watery is the very because intestine the through quickly, it passes patients. ileostomy for electrolytes and primary a is concern absorbed.water This are WHAT YOU CAN DO YOU WHAT WHAT YOU CAN DO YOU WHAT Bleeding Diarrhea 2016 Ostomy Skills Kit Booklet_v5.indd 31 30 32 33 Stoma Prolapse Stoma prolapse means the stoma becomes longer and sticks out (protrudes) higher above the surrounding skin.

WHAT YOU CAN DO

ff As long as the stoma remains red and stays moist, this is not a medical emergency.

ff Contact your surgeon or nurse and let them know this has happened. Let them know if you need help with applying your pouch.

Stoma Retraction Stoma retraction means the stoma is at or below the skin level. It looks like it is shrinking.

WHAT YOU CAN DO

ff As long as the stoma continues to put out urine or stool, this is not a medical emergency.

ff Contact your surgeon or nurse to let them know this has happened. Stoma retraction may make it difficult to keep a good seal on the pouching system. Your medical team will help you adjust your pouch system so you have a good seal.

No Output from the Ostomy Your ostomy is usually active. You may have an obstruction if you have cramps or nausea and no output for:

ff Ileostomy: 4 to 6 hours ff Urostomy: 2 to 4 hours ff Colostomy: 12 to 24 hours

There may be blockage from food or adhesions (internal scar tissue).

American College of Surgeons • Division of Education

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Surgical Patient Education Patient Surgical SAMPLE A deep cut in your stoma A deep your in cut stoma fromred a bright your color in color in change A severe mean that could color in A change a dark,to red color. purplish enough not blood being not there’s stoma. the is It supplied to happen will after from this hospital. the that discharge likely Severe skin breakdown not that is improving dehydration of signs with diarrhea Continuous no and cramping output from the Severe stoma for a period 6 hours 4 to of A large amount of bleeding continuous vomiting and nausea Continuous or bleeding the blood in pouch, finding Repeatedly between edge the skin stoma the and of (more than four tablespoons) into the pouch the into four tablespoons) than (more f f f f f f f f Chew foods especially high-fiberChew well, as whole foods such skins, seeds. and vegetables, coleslaw, Chinese corn, celery, see these may appear pouch the in undigested. You blockage the think If food, be you to might due massage gently help increase may This abdomenthe stoma site. the around right help and food the pressure blockage out. come to local surgeon nurse your or WOC or emergency your go to Call blockage or have startdepartment to vomit. continue to if you f f f f f f f f f f f Contact surgeon or nurse or go your immediately to nearestthe emergency room have: if you f f f WHAT YOU CAN DO YOU WHAT Medical Emergencies 2016 Ostomy Skills Kit Booklet_v5.indd 33 32 34 35

American College of Surgeons • Division of Education

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Surgical Patient Education Patient Surgical SAMPLE This problem may be prevented by emptying by be problemThis prevented may pouch the before right go to you or drinking hours a few stop eating before to want bedtime. also may bed. You output, pouch of a larger can night. use amount then you at a large have If you z z Modern pouchesverythoughthe pretty is lie even pouch so your body, against flat see cannot it under most usually clothes. Emptying you you, pouch to obvious your it from keep full will bulging. specially There designed also support are when it’s 1/3 belts underwear and help bicycle secure may pouch; the to girdles pants stretch and periodshelp during activity. increased belt of pouching If your system your crosses try to want suspenders. wearing may so you pants the pressure, can cause line, body your of The cause on a full pouch pressure may bedleakage your of soiling and linens. You can have sex when you feel ready, your wound site has healed surgeon/ has your and site wound your sex when feel you can have ready, You partner your to about activities. all resume to permission Talk you given nurse has can You body about your in changes the intimacy. and have you concerns any comfort empty help your with to are may Some adjust. other help each that steps pouch. the that Be aware conceal or lingerie to use pouch,the a pouch use cover, extra decrease any help to may pressure New positions odor. be not will there any rectum and colon had their the on pouch. the removed, women who have For feel vaginal with penetration. different may have Somesensations menmay difficultyerectionhaving an questions,any feel have the after operation.you If doctor your free to talk or to Pregnancy nurse. ostomy. an possible following is Urostomy: Since urine continues to flow throughout the night, you will you will night, thethroughout flow to urine continues Since Urostomy: pouch nighttime the bag. drainage to attach urostomy your f f f f f f f f There’s more to having an ostomy than changing pouches. You will have to to have will pouches. changing than You ostomy an having more to There’s your home of areas different the adjustments. other few a Let’s go over make someeveryday activities. to accomplish find and management out how and Other Resources Home Management BEDROOM Dressing Sleeping Overview Intimacy 2016 Ostomy Skills Kit Booklet_v5.indd 35 34 36 37

BATHROOM

Your Medicine ff Some changes may need to be made to your regular medications. Let your primary care doctor and pharmacist know that you have an ostomy. With an ileostomy, coated tablets and extended-release medications may come out whole into the pouch or pass through too quickly to be fully absorbed. Medication may have to be changed to a liquid or gel. Bathing ff You may shower with or without the pouch on. Many people find it easiest to change the pouch system during shower time. Remove the entire pouch and barrier prior to the bath or shower. Clean and inspect the skin, then apply the new barrier and pouch. Since a urostomy and ileostomy drain often, it may work best to remove the pouch at the end of the bath or shower, which keeps stool or urine from ending up in the tub water or on the floor of the shower. When you shower without the pouch, remember that soap and water do not hurt the stoma. Avoid lotions and oils on the peristomal skin.

Toilet ff A drainable pouch should be emptied when it is 1/3 to 1/2 full. Pouch deodorant can help to decrease stool odor. ff If you have a disposable pouch, you will need to have a supply of disposable waste bags in your bathroom. The soiled pouch will need to be placed in a sealed bag and then thrown in the trash.

KITCHEN/DIET

Ileostomy/Colostomy ff Once you have been given the OK by your surgeon, you can return to eating a well- balanced diet. You may want to start on a low-fiber, low-residue diet and then advance to a regular diet. As you add new foods, you will see the effect they have on your ostomy management. A dietician can work with you to help with food adjustments. ff Chewing your food thoroughly and eating 3 or more small meals daily may be helpful. ff Foods that can cause gas: zz Beer, carbonated beverages, broccoli, cabbage, beans, onions, Brussels sprouts, cucumbers zz You may also have an increase in gas from swallowing air while you eat or from chewing gum, smoking, drinking from a straw, or sucking on candy. ff Foods that can cause an odor: zz Fish, eggs, garlic, beans, turnips, cheese, cabbage zz Your ostomy pouch is odor proof, so the only time you will notice an odor is when you empty the pouch. ff Foods that thicken stool: zz Pudding, creamy peanut butter, baked apples/ applesauce, pasta, rice, cheese, bread, potatoes

American College of Surgeons • Division of Education

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Surgical Patient Education Patient Surgical SAMPLE Nuts, celery, coconut, mushrooms, raw raw mushrooms, coconut, Nuts, celery, vegetables,crunchy dried fruits, popcorn Cranberry noncaffeinated juice, drinks can helpurine decrease day odor. a fluid of glasses Drinking 10 8 to Asparagus, onions, garlic onions, Asparagus, Beans (brown, black, kidney, pinto, lentils, lima, lima, lentils, pinto, black, (brown, Beans kidney, oats,cereal, brown fiber-rich avocados, soybeans), greens, pasta, wheat turnip fruitrice, (raspberries, grapefruit, pears, papaya, apples skin), with potatoes skin, with sweet potatoes, yams z z z z z z z z z z Foods that can cause blockage can cause that Foods well: if chewed not High-fiber foodsthat can decrease stools keep and soft:constipation You should be able to return to work or school work be should return to as able to You 6 weeks 3 to usually soon heal, after you as the operation. surgeon know Let your type the work of heavy lifting. especially if it involves do, you that or play gym students return to not will class Usually, sportsstrenuous weeks 6 for after operation. the Drinks that decrease odor decrease Drinks that hear may general,In be should you entertain able to before. as You Usually digestion. during ileostomy/colostomy your from coming noise small eating and slowly Eating else. anyone barely by heard is noise the sounds. decrease digestive the may day the throughout meals Foods that increase odor You will need to have extra need will have clothes. of possibly and to a change supplies You people the Be tell prepared will you for meet what you about operation. your Tell them very tell can also little still and You know. them to want you as much them as had abdominal surgery you that simply say or had part removed. colon your of f f f f f f f f f f f f f f f f f f Following a urostomy, there are usually no restrictions usually are there a urostomy, Following pouch ostomy or drink. can eat you on what Your notice will so only the you odor time is proof, odoran when empty you is pouch. your OUTDOORS DINING ROOM/CAFETERIA DINING ROOM/CAFETERIA Returningand School to Work Urostomy 2016 Ostomy Skills Kit Booklet_v5.indd 37 36 38 39

Traveling ff You may travel as normal with a little extra planning: zz You should not drive a car for the first week after your operation or while you are taking pain medications. zz Be sure you take extra supplies, since they may not be available while traveling. Take the phone number of where you can get your products just in case you have to order more in an emergency. zz For airline travel, pack supplies in your carry-on luggage. Precut the pouches at home because scissors won’t be allowed in a carry-on. You should also have a note from your doctor identifying that you need the pouching system and also that you would need a private area in case airport security does an extended search. If you use pouch deodorants, cream, or powder, they will need to be in a sealed plastic bag for carry-on luggage. zz For road trips, check the location of your seat belt to avoid pressure on the pouch. If the seat belt rests on the pouch, put the seat belt below or above the pouch. Do not keep your pouches in areas of extreme heat, such as the back rear window or trunk of your car. If you use disposable pouches, remember that you will need zip-top bags to dispose of the pouches. Exercise and Activity ff Heavy lifting may cause a hernia near the stoma site. Do not lift anything heavier than 10 lbs. (a gallon of milk) for the first 2 to 6 weeks after your operation. Lifting limitations may last longer; consult your surgeon. ff You can return to all exercise when you feel ready. Heat and sweat may decrease a pouch’s barrier adhesive, so you may need to check your pouch more often. Special belts or binders are available to keep your pouch in place. Talk to your doctor about contact sports and a stoma guard for contact activities. ff You may swim and get in hot tubs with your ostomy. You will just need to make sure that the pouch is supported and that you keep a good seal. Suggestions include wearing a swimsuit with a high waistline and one with extra support; using a closed-end mini pouch; and checking the skin barrier to make sure you have a good seal. Support belts especially made for added security during swimming are available. Some people tape the edges of the barrier. Family Discussion ff Your family and dear friends will want to understand more about your operation and care. Initially, you may feel tired and need help with daily routines. Soon, changing and emptying your pouch will be managed quickly and require little extra attention. Some things you might want to talk about include: who should know about the ostomy, how each person feels about the operation, and what to do if someone notices a pouch leak (for example, signal system).

American College of Surgeons • Division of Education

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Surgical Patient Education Patient Surgical ) for suggestions. You may need supplies. If you may for a prescription ostomy ) for suggestions. You SAMPLE www.ostomy.org Have your supplies ordered for you before you leave the hospital. It may take 1 to 2 days 2 days 1 to take hospital. the may It ordered supplies before for you your leave you Have a delay. case is there in supplies of days hospital the several with Leave arrive. for them to can beSupplies ordered a local through medical equipment or pharmacy store or a see to have if they company insurance your Check with order company. Internet national America of Associations contact Ostomy can also United the preferred providers. You ( hospital supplies. Check your with order be your to assigned home may they health, have you need.supplies the of coverage specific planner for your the for details discharge Notes: Other supplies include (company name and product name and number): Other (company include supplies Other contacts: product and number): (company is system pouching current Your My ostomy/WOC nurse’s name and number: name and nurse’s ostomy/WOC My My surgeon’s name and number:My surgeon’s Your Ostomy Care Supplies Supplies Care Ostomy Your Your Discharge Your Medical Professionals’ ContactInformation 2016 Ostomy Skills Kit Booklet_v5.indd 39 38 40 41 Additional Ostomy Resources

American College of Surgeons Surgical Patient Education Program http://surgicalpatienteducation.org 1-800 - 621- 4111

Wound, Ostomy and Continence Nurses Society (WOCN®) www.wocn.org 1-888-224-9626

United Ostomy Associations of America (UOAA) www.ostomy.org 1-800-826-0826

American Society of Colon and Rectal Surgeons (ASCRS) www.fascrs.org

American Urological Association (AUA) www.auanet.org

American Pediatric Surgical Association (APSA) www.eapsa.org

American Pediatric Surgical Nurses Association (APSNA) www.apsna.org

American College of Surgeons • Division of Education

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5/23/2016 5:43:05 PM Question 3 – A, B, and C Question 4 – A, B, C, and D

Question 1 – A and B Question 2 – B

Surgical Patient Education Patient Surgical Answers: Answers: SAMPLE Every 5 days 3 to Keep the skin barrier opening closethe to edge of the stoma Don’t wear the skin barrier too long When totally it is filled When one-third it is half to full Use skinUse barrier powder if the skin around the stoma red is and weepy Check theskin surrounding the stoma for redness Clean the skin around the stoma with alcohol Check thestoma color Check thestoma for bleeding Once a day Change the pouch if liquid seeps under the barrier You can control when urineYou and stool through leave your stoma The stoma can vary in size The stoma will be dry The stoma will stick out of your body

B. B. B. D. D. B. D. D. C. C. C. C. A. A. A. A. Each question can have more than one correct more than Each question answer. can have When should you empty pouch? you When should your Which statements about your new stoma are true? What are some of can the you treat ways skin irritation? Which steps important are when cleaning inspecting and skin? your QUESTION 1 QUESTION 3 QUESTION 2 QUESTION 4 Check Your Knowledge Check Your 2016 Ostomy Skills Kit Booklet_v5.indd 41 40 43

Martin L. Dresner, MD, FACS ACS SURGICAL PATIENT Chief, Department of Urology EDUCATION PROGRAM Southern Arizona VA Healthcare System Tucson, AZ Director: Ajit K. Sachdeva MD, FACS, FRCSC John Easly Assistant Director: Patient Advocate Kathleen Heneghan, PhD, RN Ostomy Support Group of DuPage County Clarendon Hills, IL Manager: Nancy Strand, RN, MPH Kathleen G. Lawrence, Program Coordinator: MSN, RN, CWOCN Mandy Bruggeman Wound, Ostomy and Continence Nurses Society (WOCN®) Mt. Laurel, NJ PATIENT EDUCATION COMMITTEE Ann Lowry, MD, FACS Colon-Rectal Surgery Ajit K. Sachdeva, MD, FACS, FRCSC Fairview Southdale Hospital John M. Daly, MD, FACS Minneapolis, MN Eileen M. Duggen, MD (Resident Member) David V. Feliciano, MD, FACS Jack McAninch, MD, FACS, FRCS Frederick L. Greene, MD, FACS Department of Urology B.J. Hancock, MD, FACS, FRCSC San Francisco General Hospital Dennis H. Kraus, MD FACS San Francisco, CA Michael F. McGee, MD, FACS Mike McGee, MD, FACS Beth H. Sutton, MD, FACS Colon and Rectal Surgery Michael J. Zinner, MD, FACS Northwestern Memorial Hospital Chicago, IL Marletta Reynolds, MD, FACS OSTOMY TASK FORCE Pediatric Surgery Ann and Robert H. Lurie Children’s H. Randolph Bailey, MD, FACS Hospital of Chicago Colon and Rectal Surgery Chicago IL The Methodist Hospital, Houston, TX David Rudzin Teri Coha, APN, CWOCN United Ostomy Associations Pediatric Surgery of America, Inc. Ann and Robert H. Lurie Children’s Northfield, MN Hospital of Chicago Chicago, IL Nicolette Zuecca, MPA, CAE Wound, Ostomy and Continence Janice C. Colwell, RN, Nurses Society (WOCN®) MS, CWOCN, FAAN Mt. Laurel, NJ Ostomy Care Services University of Chicago Medicine Chicago, IL

American College of Surgeons • Division of Education

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Surgical Patient Education Patient Surgical SAMPLE DISCLAIMER The information contained in the patient education section education patient the in contained The information does website (ACS) Surgeons of College American the of published is information This advice. medical constitute not educate to and inform to vehicle a communications as not is It procedures. surgical specific about public the a qualified with a discussion of place the take to intended important to is It situation. your with familiar is who surgeon reasons the and different, is individual each remember that depend operation upon patient’s the any of outcomes and condition. medical other or state, disease diagnosis, specific that organization and educational a scientific is The ACS of practice competent and ethical the to dedicated is surgical of standards the raise to founded was it surgery; surgical the for care of quality the improve to and practice information present to endeavored has The ACS patient. scientific current on based patients surgical prospective for accuracy, timeliness, the on warranty no is there information; no circumstances Under content. this of or usefulness incidental, direct, indirect, for be liable ACS the will result that damages or consequential or punitive, special resource. electronic this of use your from way any in 2016 Surgeons of College © American 2016 Ostomy Skills Kit Booklet_v5.indd 43 Winner Excellence in Ostomy Communication HOME SKILLS KIT©

This program was created by the American College of Surgeons in collaboration with the following:

American Urological Association (AUA) American Society of Colon and Rectal Surgeons (ASCRS) Wound, Ostomy and Continence Nurses Society (WOCN®) United Ostomy Associations of America (UOAA American Pediatric Surgical Association (APSA) American Pediatric Surgical Nurses Association (APSNA)

This kit is made possible in part by the generous support of an education grant from Coloplast Corp.

surgicalpatienteducation.org

AMERICAN COLLEGE OF SURGEONS | DIVISION OF EDUCATION Blended Surgical Education and Training for Life®

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