SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE

Transcription

1 SARASOTA MEMORIAL HOSPITAL TITLE: ISSUED FOR: PURPOSE: NURSING PROCEDURE UROSTOMY AND ILEAL CONDUIT: CARE AND Nursing DATE: REVIEWED: PAGES: RESPONSIBILITY: RN, LPN, Patient 06/81 3/18 1 of 5 1. To provide an effective and secure system for the care of a patient with a urinary diversion. 2. To prevent peristomal skin breakdown or damage from the caustic effects of exposure of the skin to urine. 3. To provide the patient with a safe and reliable ostomy system that will aid in recovery after surgery and throughout the rehabilitation period. KNOWLEDGE BASE: 1. Request a consult with a Wound/Ostomy nurse for assessment, evaluation and patient teaching post-op. 2. The patient may have a one or two piece appliance selected for stoma management. The 2-piece appliance consists of a: a. Skin barrier (wafer), 2 ¼ b. Urostomy pouch, 2 ¼ c. *Adapter to use with bedside drainage. The adapter is used to connect the pouch to the tubing of the bedside drainage bag (accuseal connector). 4. The wafers and pouches are obtained from Central Services and one size is stocked. Wafers and pouches are available separately. Wafers can be ordered individually. Pouches are dispensed by the box. 5. Standard precautions will apply. 6. Patient Care techs (PCT) and MST s can empty and also change an ostomy pouch. INDICATIONS: The purpose of the skin barrier and pouch is to replace the internal anatomical structures of the urinary tract that enable elimination and provide continence, with an external collection system. The goal is to return the patient to normal activity and lifestyle as much as is possible. The alterations in body image and body function are obstacles to overcome; but, successful adaptation that includes patient and family teaching will assist with this goal.

2 PAGE: 2 of 5 The components of the appliance may be changed as follows: 1. Wafer : a. The wafer is changed for any of the following reasons: leakage, patient complaints of unusual burning, itching and/or soreness around the stoma, exposed peristomal skin inside the wafer flange. b. The wafer is routinely changed about twice per week and as needed. Wear time and the frequency of appliance change varies among patients. Most patients determine the frequency based on personal experience. 2. Urostomy Pouches: a. Pouches are usually worn for several days, then removed and discarded. b. Pouches may be removed daily, cleaned with cool, soapy water, allowed to dry and reused. c. Pouches should be emptied when 1/3 full. d. Pouches should be connected to bedside drainage at bedtime or if patient is unable to empty the pouch independently (Use the adapter to connect). *Patient preference determines how long a pouch is worn or how often it should be reused. However, during hospitalization, twice per week is suitable wear time. EQUIPMENT: 1. Obtain from Central Services: a. Wafer b. Pouch c. Kendall preppies d. Eakin Seals if the stoma is flush to the skin 2. Obtain from Nursing Unit: a. Towel b. Disposable suture kit/scissors c. 4-X-4s d. Unsterile gloves e. Appropriate waste container f. Urinary drainage bag PROCEDURE: 1. Introduce yourself and identify your patient. 2. Perform hand hygiene. Don gloves. 3. For best assessment of the abdomen, have the patient lie in bed with the head of the bed elevated degrees

3 PAGE: 3 of 5 4. Assess stoma, stoma function, color and consistency of drainage, whether stents are in place, and peristomal skin. 5. Review the following with the patient: the equipment, the reason for changing, and each step of the procedure. 6. Use the opportunity to provide education to patient and support person while providing care. TO CONNECT THE POUCH TO BEDSIDE DRAINAGE: 1. Remove cover from the spout of the urostomy pouch and clip the accuseal adapter to the spout. 2. Connect the urinary drainage bag tubing to the end of the accuseal connector. 3. Open the valve at the bottom of the urostomy pouch (red arrow is visible, indicating open to drainage). TO EMPTY THE UROSTOMY POUCH: 1. Remove the cover from the spout of the urostomy pouch. 2. Open valve (red arrow visible). 3. Drain urine into graduate pitcher. 4. Close valve (red arrow not visible) and replace cover on spout. TO CHANGE THE UROSTOMY POUCH: 1. Remove pouch carefully so as not to dislodge stents, if present, and discard or lay aside to be cleaned. 2. Blot stoma or stents with dry 4-x-4s. 3. Apply the clean pouch, making sure that it is securely fastened to the wafer flange. TO CHANGE THE UROSTOMY POUCH AND WAFER: 1. Empty urostomy pouch or disconnect from bedside drainage system. Remove the wafer and pouch as one (take care not to dislodge stents if present). Discard pouch and wafer appropriately.

4 PAGE: 4 of 5 2. Cover stoma or stents with dry 4-X-4 to absorb urine as you carefully remove the wafer and pouch. 3. Gently clean the stoma site as follows: a. Hold a rolled, dry 4-X-4 over stoma or stents to absorb urine as you clean the stoma and peristomal skin with warm, moist 4-X-4s or a washcloth. Use warm water and pat dry. b. Apply skin protector to the peristomal skin (i.e. skin barrier wipes). 4. Prepare the wafer: a. Measure stoma or use pattern, if available, and trace onto paper backing of new wafer, cut opening so it is about 1/8 larger than the diameter of the stoma. The wafer edge should not touch the stoma. b. Remove paper backing from wafer. *Stoma paste is not used for urostomy care. Obtain Eakin Seal from CS. For extra skin protection, place an Eakin Seal around the stoma before applying the wafer. Eakin Seals can be stretched and molded to fit snugly around the stoma. 5. Place the wafer gently in position over the stoma. Apply light pressure for 2-3 minutes especially at the base of the stoma to ensure adhesion of wafer to skin. NOTE: Continue to hold a rolled 4-X-4 over the stoma to absorb the urine as you are applying the wafer. The peristomal skin must be dry or the wafer will not adhere. 6. The disposable pouch is attached in the following manner: a. Position the pouch flange onto the wafer flange at its bottom edge while applying even pressure around the rim until it is completely sealed. Tug pouch to test. b. Open the flip valve at the bottom of the pouch so the red arrow shows. c. Attach accuseal connector. * d. Connect pouch to bedside drainage. *(IF patient is ambulatory, do this only at bedtime) 7. Clean work area. Return patient supplies to appropriate bedside storing area.

5 PAGE: 5 of 5 DOCUMENTATION: Ostomy Flowsheet: Document that the wafer and pouch were changed, the appearance of stoma and peristomal skin: amount, color and consistency of urine; patient teaching with the patient s degree of acceptance and participation in self care. Enter any other appropriate comments as needed. Document patient progress with skill development or any barriers to learning. REFERENCE: Lippincott. (2015). Lippincott s Nursing Procedures-7th edition. (p ). Lippincott Williams and Wilkins. Philadelphia: PA. REVIEWING AUTHOR(S): Pam Jackson, BSN, RN-BC, CWOCN, Wound/Ostomy RN Jovan Huss, BSN, RN, WCC, Wound/Ostomy RN Sandy Davis, MSN, RN, Wound/Ostomy RN Karen Rinehart, RN, Wound/Ostomy APPROVAL : Clinical Practice Council 3/1/18