a procedure used by colostomates to clear the bowel of fecal matter and to help establish an evacuation schedule.
method Daily irrigation may be ordered beginning 7 to 10 days after the surgery, and the patient is involved in assisting in the procedure as soon as possible. In preparation for self-care, the technique is explained in a step-by-step manner, and irrigation is carried out with the equipment the patient will use at home. In the hospital the procedure is performed as the patient sits in bed in a semi- or high-Fowler's position or on a commode, if ambulatory. At home the individual will probably find a toilet more convenient. A flexible catheter, lubricated with water-soluble lubricant, is gently inserted into the stoma to a depth of no more than 3 inches; the catheter tip is advanced only as far as it will go easily and is never forced. A cone tip on the tubing controls the depth of insertion and prevents water from coming out of the stoma. An irrigating bag containing 500 to 1000 mL of warm solution is held 12 to 18 inches above the stoma, and the fluid is allowed to flow slowly into the colon. If the patient complains of cramps, the catheter is clamped for a few minutes before the flow is resumed. The fluid is retained for several minutes and then drained through outlet tubing into a basin or commode. From 30 to 45 minutes is allowed for draining; if the return is slow, the patient is asked to lean forward or move from side to side; the abdomen may be massaged. The character and amount of the return flow are noted. The peristomal skin is cleaned, rinsed, and dried well. A dehydrated patient may retain some fluid.
interventions The nurse performs and teaches colostomy irrigation and ensures that the patient knows how to carry out the procedure correctly and where to purchase the necessary equipment. The person is urged to report any symptoms of obstruction or prolapse of the stoma. A home nurse is available in many areas for home visits if help is needed.
outcome criteria Many colostomates establish a regular schedule of evacuation with irrigation; but the procedure may be unsatisfactory for those who have a liquid or semisoft fecal stream, for patients who before the operation had a tendency to experience diarrhea under stress, or for patients with irregular bowel habits.