Colostomy (Pediatric)

A colostomy is a reversible surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel for feces to leave the body.

Colostomies are often used in cases of Imperforate Anus and other conditions where there is a defect in the colon or large intestine.

Colostomy Care Instructional Videos

Videos, developed by pediatric surgery nurses at UCSF Benioff Children's Hospital, explain the different types of ostomies and stomas and their location on the abdomen. Some ostomies are permanent and others temporary. The videos also demonstrate how to care for a stoma, including how to empty, remove and apply a pouch.

• Caring for Your Child's Stoma
  This video offers an introduction and overview of stoma management in children with a demonstration of stoma pouch application on a manikin.
• Ostomy Pouching for Infants
  Learn how a mother feels about caring for her infant's colostomy and watch while she shows viewers how to apply, empty and remove a pouch.
• Ostomy Pouching for Children
  Listen to a mother and her school-age daughter explain what it means to live with an ileostomy. Watch this video for tips when applying, emptying and removing a pouch.
• Ostomy Pouching for Teens
  Learn how this teen feels about having an ileostomy and watch while she shows viewers how to apply, empty and remove a pouch.

Pouch Selection

Pouch systems are available in many styles and sizes. They consist of a sticky wafer that adheres to the skin and a pouch to collect the stool. There are one piece systems and two piece systems. A one piece pouch has the wafer and pouch joined together as a single unit. A two piece system has a wafer and pouch that are separate. Pouches are available with an opened or closed end. Open end pouches are used most commonly as they allow you to easily drain the pouch of air and stool. Open end or "drainable" pouches require a clip on the end to keep them sealed. This is called a "tail closure".

There are additional supplies that may be required including stoma paste and stoma powder. The surgical nurse will help determine the best pouch system and supplies required to suit your child's needs post operatively. With time and experience your child's needs may change and a different pouch system and supplies can be ordered.

Pouches & supplies are provided by a supply company with a physician's order. Most of these companies ship supplies directly to your home. Please be certain to contact the company when your child's supplies run low to allow adequate time for the order to be filled & shipped.

Emptying the Pouch

In general, you should be certain your child's pouch is emptied frequently. Pouches that are allowed to become full are heavy and can pull away from the skin. If this occurs the pouch system will need to be replaced.

Procedure

• Empty the pouch when it is 1/3 full of air or stool. This may be done at the time of a diaper change, or if you child is older, he or she can sit on the toilet.
• Hold the end of the pouch up before removing the clip. This allows you to control the flow of stool draining out of the pouch. Stool can be drained into a container, a diaper or, directly into the toilet. Lay a piece of toilet tissue on the water before draining the pouch to minimize splashing.

Hints

• After emptying the pouch, wipe the end inside and out before closing. You can use toilet paper or a wet wipe. Cleaning will prevent odor once the pouch is sealed. After cleaning, close the pouch as usual. Liquid deodorant can be ordered for the pouch.
• Emptying the pouch is a good time to inspect the integrity of the wafer and the pouch. If it is loose or leaking, the system must be changed to prevent stool from irritating the skin around the stoma.
• Empty the pouch prior to naptime or before your child goes to bed at night.

Changing the Pouch

The frequency of pouch changes depends on many things. Ideally a pouch should last one to several days between changes. If the pouch must be changed more than once a day, call our office or your home care nurse for advice. A good time to change a pouch is before a meal or several hours after eating, when the stoma is draining less. If your child experiences irritation or discomfort of the stoma area, it may mean there is stool leaking onto the skin & causing irritation. If this happens, change the pouch right away.

Supplies

• Appropriate size pouch: one or two piece
• Permanent marking pen
• Tail closure, if needed (clip that keeps pouch closed)
• Template (pattern) for stoma
• Scissors
• Skin cleansing supplies
• As needed:
• Stoma paste and small syringe
• Deodorant for pouch
• Stoma powder
• Adhesive remover or mineral oil
• Belt, if using
• Cavilon® 3M no sting barrier film

Procedure

• Carefully remove old pouch with mineral oil, or alcohol free adhesive remover. Wash and set aside the re-usable clip.
• Clean skin gently. You may give your child a tub bath or shower with the pouch off.
• Observe the stoma for changes in size & color. A slight amount of bleeding from the stoma can be normal.
• Evaluate condition of surrounding skin.
• If the stoma is round, use the precut template to find a pattern that fits best.
• A good fit means there should is no skin visible around the stoma. Date the template.
• If the stoma is irregular in shape, use a firm piece of clear plastic to trace a pattern of the stoma. Use this as your template. Date the template.
• Use the template to trace an opening on the wafer, the adhesive portion of the pouch.
• Cut out your tracing with sharp scissors. Do not cut beyond the cutting guide.
• Smooth out rough edges with your finger.
• Warm the wafer in your hand to soften.
• Apply Cavilon® 3M no sting barrier film to skin around stoma
• If the pouch has 2 pieces, you can attach the pouch to the wafer now, or attach the pouch after the wafer is applied to the skin.
• Remove the paper backing from the wafer. If you are using paste, apply sparingly to the wafer around the hand cut opening or apply to the skin where it meets the stoma.
• Press the pouch on to the skin using light pressure with your hand. This will promote a secure attachment.
• Apply clip to end of pouch.
• Empty the pouch when 1/3 full of air or stool.
• Change the entire pouch when the wafer comes loose from the skin.
• Do not flush pouch or wipes down the toilet.

Hints

• Templates need to be checked for size frequently, especially when the stoma is new, because the stoma may change in size. A template that is too large will lead to damaged skin immediately around the stoma. A template that is too small will irritate the stoma.
• Stoma paste is especially useful to fill in areas around the stoma that are uneven and may cause the pouch to leak. Paste is also helpful when placed immediately next to the stoma, to minimize leaking. Do not use too much, it may be difficult to remove.
• Stoma powder helps dry out any ulcerated or eroded skin. Too much powder can prevent the pouch from sticking. Be sure to blow off excess after application and rub in well to ensure that the pouch will stick.
• Areas of skin that are irritated or damaged will benefit from a pouch that adheres well to the skin & does not leak. The irritated skin will heal under the pouch quickly if it remains covered & protected from stool.

Diaper Method For Sigmoid Colostomy

To be used when stools are thick and pasty, usually from the descending colon.

Supplies

• A barrier paste such as Butt Balm or Ilex Paste®.
• Skin barrier
• Soft and thick paper towels.
• Surgical tape
• Cavilon® 3M no sting barrier film

Procedure

• Clean around stoma well with warm water. A bath is very soothing to the skin & will not harm the stoma.
• Apply Cavilon® 3M no sting barrier film to skin around stoma
• Cover the area surrounding the stoma with a thick (1/8 - 1/4 inch) layer of the Ilex® or Butt Balm paste.
• Cut two large strips of the skin barrier to fit on either side of the applied paste.
• Fold the paper towels in quarters and apply to cover the stoma and paste. Tape towel to skin barrier strips with tape.
• Change the paper towel as needed. Remove stool from paste & apply more paste and a paper towel.
• Diaper as usual.
• Remove all the paste from skin every day with mineral oil and/or a tub bath. This is a good time to check the skin around the stoma.
• Do not flush wipes down the toilet.