The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [208]
Procedure guideline 6.12 Stoma care
Essential equipment
Clean tray holding
Tissues, wipes
New appliance
Measuring device/template
Scissors
Disposal bags for used appliances, tissues and wipes
Relevant accessories, for example adhesive remover, protective film, seals/washers
Bowl of warm water
Soap (if desired)
Jug for contents of appliance
Gloves
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).
To familiarize the patient with the procedure.
2 Ensure that the patient is in a suitable and comfortable position where they will be able to watch the procedure, if well enough. A mirror may be used to aid visualization. To allow good access to the stoma for cleaning and for secure application of the stoma bag. The patient will become familiar with the stoma and will also learn much about the care of the stoma by observation of the nurse (Bryant 1993, P).
3 Use a small protective pad to protect the patient’s clothing from drips if the effluent is fluid and apply gloves for nurse’s protection. Avoids the necessity for renewing clothing or bedclothes and demoralization of the patient as a result of soiling. E
Procedure
4 If the bag is of the drainable type, empty the contents into a jug before removing the bag. For ease of handling the appliance and prevention of spillage. E
5 Remove the appliance. Peel the adhesive off the skin with one hand while exerting gentle pressure on the skin with the other. To reduce trauma to the skin. Erythema as a result of removing the appliance is normal and quickly settles (Broadwell 1987, C).
6 Fold appliance in two to ensure no spillage and place in disposal bag. To ensure safe disposal according to environmental policy (DH 2005a, C).
7 Remove excess faeces or mucus from the stoma with a damp tissue. So that the stoma and surrounding skin are clearly visible. E
8 Examine the skin and stoma for soreness, ulceration or other unusual phenomena. If the skin is unblemished and the stoma is a healthy red colour, proceed. For the prevention of complications or the treatment of existing problems. E
9 Wash the skin and stoma gently until they are clean. To promote cleanliness and prevent skin excoriation. E
10 Dry the skin and stoma gently but thoroughly. The appliance will attach more securely to dry skin. E,C
11 Measure the stoma and cut appliance leaving 3 mm clearance. Apply a clean appliance. Appliance should provide skin protection. The aperture should be cut just a little larger than the stoma so that effluent cannot cause skin damage. This should be no more than 3 mm from the stoma (Kirkwood 2006, C).
Postprocedure
12 Dispose of soiled tissues and the used appliance in a disposable bag and place it in an appropriate plastic bin. At home the bag should be placed in a plastic bag, tied and disposed of in a rubbish bag. To ensure safe disposal. E
13 Wash hands thoroughly using bactericidal soap and water or bactericidal alcohol handrub. To prevent spread of infection by contaminated hands (Fraise and Bradley 2009, E).
Procedure guideline 6.13 Stoma bridge or rod removal
Essential equipment
Clean tray holding
Tissues
New appliances
Disposal bags for used appliances and tissues
Relevant accessories, for example belt
Bowl of warm water
Soap if desired
Jug for contents of appliance
Gloves
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).
2 Ensure the patient is in a suitable and comfortable position. To allow good access to the stoma for cleaning and for secure application of stoma bag. E
3 Apply gloves. To reduce