stoma care part 1: cutting a template for a one-piece

Protouch

Protouch

350Examination Gloves

100PCS

Ref:Ambidextrous

Size Large

350Ambidextrous

Examination Gloves Ref:

Size Large

100PCS

Template

Curved scissors

Pen

Non-sterile gloves Apron

Stoma measuring guide

Apron

A colostomy is a stoma made from the large bowel or colon; it is made by bringing a piece of colon through an incision in the abdominal wall, which is sutured into position. Colostomies are usually formed from the sigmoid colon and are therefore situated in the left iliac fossa. However, a colostomy can be raised anywhere along the length of the colon; for example a transverse loop colostomy may be formed for palliation of obstruction.

of 3

Endsigmoidcolostomy

Transverseloopcolostomy

Right iliac fossa

Left iliac fossa

Rightlumbar

Leftlumbar

Ileostomy

Right iliac fossa

Left iliac fossa

Rightlumbar

Left lumbar

Stoma CareAdults

The anatomical position of a colostomy

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

An Ileostomy is a stoma made from the small bowel or ileum. This type of stoma is formed, whenever possible, from the terminal ileum in order to have the full length of the ileum available for absorption of nutrients, and is usually situated in the right iliac fossa. Ileostomies are “spouted” to ensure that semi-liquid faeces are not in contact with the skin, preventing skin damage.

Explain the procedure to the patient and gain consent. Gather together all of the equipment that you will need before you begin. Ideally, make sure that the scissors are sharp and curved to ensure a smooth cut.

Anatomical position of an ileostomy Assemble equipment

The word “stoma” comes from the Greek word for mouth or opening. Following resection of the bowel, the surgeon may bring the remaining bowel through the abdominal wall and suture it to the skin to form a colostomy (large bowel stoma) or an ileostomy (small bowel stoma). The stoma will enable faeces to drain into an appliance. Surgery may be necessary for conditions such as carcinoma, ulcerative colitis, Crohn’s disease, diverticulitis, ischaemia, trauma, volvulus, slow-transit constipation and incontinence, radiation damage or as a palliative procedure for bowel obstruction. (A urostomy is created by implanting the ureters into an isolated section of the small bowel to enable urine to drain for patients without a functioning bladder, e.g., due to incontinence or bladder cancer.)Stomas are permanent or temporary. The surgeon may reverse a temporary stoma once the surgical join heals. The choice of appliance depends on the type of stoma formed. Appliances are drainable or closed (and therefore cannot be emptied). There are “one-piece” appliances, in which the adhesive base plate and pouch are joined, and “two-piece” appliances, in which the pouch clips onto or sticks to the separate base plate.Patients with a new stoma undergo physical and psychological adaptation. It is vital that they feel that their appliance is well-fitting, secure and discreet. Teach patients self care as soon as possible to promote independence in normal daily activities and to aid psychological adaptation. When caring for these patients, avoid showing any aversion to the smell or the procedure, in order to support their ability to cope with the stoma. This guide describes how to cut an accurate template for a one-piece ileostomy or colostomy appliance when it needs changing. When a stoma is formed, it is swollen (oedematous). It will reduce in size over the next 2–4 weeks for an ileostomy and 6–8 weeks for a colostomy. During this time, frequently resize the template to ensure an accurate fit. If the template is too big, a prolonged exposure of faeces causes the abdominal skin to become excoriated and painful. A template that is too tight can cause trauma to the stoma and/or leakage. Check the template annually; it can change due to factors such as weight change or hernia formation.

Stoma care Part 1: Cutting a template for a one-piece appliance

Maddie White, Colorectal Nurse Specialist, University Hospitals Birmingham NHS Foundation Trust

©2021 Clinical Skills Limited. All rights reserved

The stoma (ileostomy) looks to me to be in the caecum - move right into the thinner, paler small bowel (suggested by peer review-er, agreed by author) LF 300921 - see https://www.securicaremedical.co.uk/me-dia/Stoma-Care-for-HCAs.pdf

Stoma Care

Adults


Page 2 of 3

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

Ensure privacy and make sure that the patient is comfortable. Decontaminate your hands using an alcohol-based hand sanitiser. Put on an apron and non-sterile gloves.

Change closed appliances, suitable for those who have less frequent bowel actions, up to three times a day. Change drainable appliances (used postoperatively and for ileostomies) daily or leave in place for up to 3–4 days, according to the manufacturer’s guidelines and patient preference.

50mm40mm30mm

55mm 45mm 35mm 25mm

STOP!

15mm - 55m

m

76mm 55 45 35 25 1 1 1 2 3”

6050403020

3/8 3/4 1/8

7/81/45/8

3/8

112

2

MAX

Decontaminate your hands, put on apron and gloves One-piece appliances

The base plate on the back of the appliance has a size guide to aid cutting. This method is useful if the stoma is round in shape. Place the stoma measuring guide over the stoma onto the abdominal skin. It should fit around the stoma with about a 1–3-mm gap between the guide and the stoma. Find the correct size.

STOP

!

STOP!

25mm

38mm

51mm

1” 1 ” 2”1/2

1 ”

1 ”

2 ”

3/4

1/4

1/2

32mm

64mm44mm

Appliance cutting guide Method for a round stoma: (a) Measure the stoma

Place the measuring guide over the base plate of the appliance and draw around the measurement guide to transfer the stoma size directly onto the base plate.

Pull the pouch away from the base plate before cutting as there is a risk of piercing it with the scissors.

Stomameasuring

guide

10mm

55mm

20mm

25mm

45mm

25mm

38mm

51mm

1” 1 ”

2”1 / 2

1 ”1 ”

2 ”

3/4

1/4

1/2

32mm

64mm

44mm

(b) Draw the stoma size onto the base plate (c) Pull the pouch away from the base plate

5C 10M 20Y

Bag is on the wrong side PG

Stoma Care

Adults


Page 3 of 3

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution

Cut the hole in the base plate. Do not “snip”; cut smoothly without jagged edges that could damage the stoma. The appliance is now ready for use; see “Part 4: Changing a one-piece appliance”. Record the stoma size, according to local policy.

If the stoma is oval or an uneven shape, cut the template “by eye”. Pull the pouch away from the base plate. Cut a hole in the base plate in the general shape of the stoma, but smaller than the stoma. Hold the base plate up to the stoma and gradually trim away more of it until you have an accurate fit.

25

mm

38

mm

51

mm

1”

1 ”

2”

1 / 2

1 ”1 ”

2 ”

3/4

1/4

1/2

3 2 m m

6 4 m m

44mm

STOP!

STOP!

STOP!

STOP!

25m

m38

mm

51m

m1”1 ”2” 1/2

1 ”1 ”2 ”

3/4

1/4

1/2

32mm

64mm

44mm

(d) Cut the hole smoothly Method for an irregular or oval-shaped stoma: (a)

Use the measurements on the guide to mark the width and depth of the stoma on the base plate at four points. Use the points as markers to draw the shape of the stoma on the base plate. Pull the pouch away from the base plate before cutting.

Keep the backing paper on the base plate until you are sure that the appliance is going to fit. Place the backing paper on top of the template and draw around the hole. Cut the template to size and keep it as a record of the stoma size, which can be used again in the future.

STOP!

STOP!

25mm

38mm

51mm

1” 1 ” 2”1/ 2

1 ”

1 ”

2 ”

3/4

1/4

1/2

32mm

64mm

44mm

(b) Alternatively, use the measuring guide (c) Cut the template to size and keep as a record

Ensure that the template records the patient’s details and the date that it was created before storing it according to local policy.

Remove and dispose of your gloves and apron. Wash your hands with soap and water, drying thoroughly.

30m

m

(11/8")

40m

m

(15/8")(2")

(23/8")(23/4")

50m

m60

mm

70m

m

Circular...........mm (to nearest1/2mm)

Elipse.............mm (top to bottom)

.............mm (left to right

Name.........................................................................................

Address.....................................................................................

..................................................................................................

...................................................Postcode................................

Date....................................................

This side away from skin, if circular or elipse in shape

12/11/2021

REG SHORT58 CRANBOURNE STREET

MIDDLESBOROUGHN4 3BP

Record the patient’s details on the templateRemove gloves and apron, wash your hands

Wid

th

Depth

stoma care part 1: cutting a template for a one-piece

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