Stoma Care

A so-called enterostoma is an artificial bowel outlet that is created as part of an intestinal surgical procedure. In this procedure, a loop of bowel is passed through the abdominal wall to the surface so that stool can be emptied through this artificial outlet. This represents an enormous hygienic challenge with regard to the care of such a stoma. Stoma care (synonym: enterostomatherapy) is a time-consuming undertaking and often means an enormous challenge for the patient, requiring intensive patient training. Patients should be recommended to join a self-help group. Especially the psychological stress of the patients due to the serious change of their body should not be underestimated. Social reintegration (re-integration) after severe illness is often the main concern. Often the enterostoma is experienced as a restriction of the quality of life, so that everyday handling is difficult to learn. The patient must learn how to care for it with the help of technical and nursing materials and aids. Cleaning and connecting the stoma, e.g. emptying an ostomy bag, is also part of patient education. The patient must also be instructed to avoid carbonated beverages and foods that promote gas formation, such as legumes and cabbage.

Indications (areas of application)

  • Hygienic care of an enterostoma

Contraindications

There are no contraindications to stoma care, it is a necessary part of hygiene and care of the enterostoma. If the stoma is not cared for with the help of an ostomy bag but is irrigated (irrigation method), the situation is different (see stoma irrigation).

The procedure

Immediately after the stoma is created, the stoma system (e.g., strut bag) is placed on the previously cleansed skin, observing skin protection. Following the operation, the stoma must be checked daily for eight days in order to detect complications at an early stage. Findings during this period may include bleeding, swelling, retraction or prolapse, necrosis (death of tissue), bluish-livid discoloration of the mucosa or an allergic reaction to the care materials. Furthermore, the suture site must be cleaned when changing the supply system. The care of the enterostoma is directly dependent on the type of supply system. The stoma supply with pouch offers a variety of supply systems, which are changed regularly. Usually, such a system consists of a plate with an opening that is glued to the skin over the enterostoma. A pouch can be attached to this plate to collect the stool. The skin and the stoma itself must be thoroughly cleaned and cared for. The supply system is usually glued to the skin, so it must first be carefully detached. The skin and the stoma are cleaned with warm water. Cleaning should always be done in the direction of the stoma to minimize soiling of the skin. This is followed by cleaning with compresses. Hair in the area should be removed. If necessary, the skin can be treated with caring lotions. The skin must be dry for adhesion of the stoma plate. Finally, the pouch is attached and fixed with a plaster if necessary.

Possible complications [therapeutic measures]

Early complications (in the first 30 days).

  • See below Enterostomy creation (creation of an artificial bowel outlet).

Late complications (after the 30th postoperative day).

  • Dehydration/body loses more fluid than it absorbs (with electrolyte disturbances/deviations from normal electrolyte concentration) → exsiccosis (dehydration due to decrease in body water) (approximately 20% of ileostomy patients).
  • Allergic contact reaction with a sharply circumscribed redness of the skin [recognition of the allergenic substance and avoidance or removal of this substance].
  • Infectious skin complications
  • Nahtrdehiszenz – partial to complete detachment of the stoma from the skin; wound edges gape open [filling the dehiscence with hydrocolloid powder and sealing, for example, with a PU foam].
  • Stoma retraction (retraction of the stoma below the skin level) [only in need of revision in case of stoma dysfunction].
  • Parastomal hernia (risk factors: Obesity and increased intra-abdominal pressure; steroid treatment secondary stoma creation; most common stoma complication: affects 40-50% of all stoma patients; leads to defecation disorders up to mechanical ileus).
  • Peristomal dermatitis (skin inflammation that occurs around the stoma).
  • Late abscess
  • Stomastosis (narrowing of the stoma until closure; settling of so-called “pencil stools”) [usually stoma aneurysm].
  • Stomaprolapse (prolapse of the bowel (bowel pushes outward through the stoma); risk factors: Obesity and increased intra-abdominal pressure).
  • Late complications in the outpatient setting.
    • Dehydration/body loses more fluid than it absorbs (with electrolyte disturbances/deviations from normal electrolyte concentrations)
    • Failure to cut out the stoma plate for an accurate fit
      • Stoma plate cut out too large can cause skin irritation
      • Too small cut out stoma plate leads to erosion of the mucosa / intestinal mucosa (with possible bleeding)
    • Incorrect temporal change of the stoma plate.

Note: Surgical revision is required only if symptoms persist and stoma function is impaired with concomitant failure of conservative measures.