Managing the Patient with a Fecal Diversion

Abstract

An effective pouching system requires an adequate seal and intact skin around the stoma. Preoperative evaluation for stoma location is important to ensure that the area is free of skin folds in the sitting, standing, and prone positions. The adhesive/hydrocolloid should be inspected for erosion upon removal of the pouching system, with shorter time between changes if there is evidence of skin barrier breakdown. Postoperatively, patients are advised to adhere to a low-residue diet; many can extend their diet after 6-weeks. Patients with high-output ostomies are advised to eat foods that thicken their effluent, especially when drinking liquids. Risk factors for complications include obesity, the presence of inflammatory bowel disease, and emergently created stomas. The most common peristomal complication, irritant contact dermatitis, is due to an inadequate seal and requires reevaluation of the pouching system and patient technique. Social support is important for patients to adapt to their new ostomy. The Wound Ostomy and Continence Nursing Society (WOCN) and the United Ostomy Associations of America provide valuable resources to ­caregivers and their patients with ostomies. The input of a trained WOC nurse is important in each step of the process for the patient who requires an ostomy.