Understanding Ostomy and Enema Procedures
Ostomy
A surgical intervention creating an opening for an organ to communicate with the outside through a non-natural hole.
Ostomy Nutrition
An alternative route of nutrition when natural feeding is prevented due to conditions like mouth or esophageal cancer, or caustic ingestion. This feeding is done through tubes: esophagostomy, pharyngostomy, gastrostomy, jejunostomy.
Stoma Types and Disposal
Externalization of the intestine to the abdominal wall, sutured to the skin to create an artificial outlet for waste evacuation. Types depend on the location:
- Ileostomy: Semi-liquid feces.
- Ascending Colostomy: Semi-liquid feces, irritating to the skin.
- Transverse Colostomy: Semi-liquid feces, slightly irritating to the skin.
- Descending Colostomy: Solid feces.
- Sigmoid Colostomy: Solid feces, does not irritate the skin.
Stoma Duration
- Temporary: When the underlying problem is resolved and intestinal transit is restored.
- Permanent: When intestinal transit cannot be restored.
Stoma Complications
Immediate Complications:
- Necrosis
- Suture dehiscence of the mucocutaneous junction
- Sinking
- Bleeding
- Infection
- Edema
Delayed Complications:
- Stenosis: Narrowing of the stoma’s exit orifice
- Hernia
- Prolapse
- Skin irritation: Redness, periostomal ulceration, and subsequent necrosis due to contact with fecal content
- Mechanical irritation caused by frequent bag changes
- Allergies or inappropriate components of the adhesive material
- Moisture
- Ulcers
Collector Types
- One-piece system: The adhesive and the bag are inseparable and form a certified stick to the skin.
- Two-piece system: The adhesive and the bag are separate. The adhesive sticks to the skin and has a device to attach the collection bag, allowing frequent bag changes without damaging the skin.
Bags can be: closed with a filter, or open with a filter.
Enema
Introduction of a solution rectally into the large intestine.
Functions of Enemas
- Promote intestinal peristalsis
- Soften stool to facilitate expulsion
- Prepare patients for diagnostic tests
- Facilitate expulsion of gas
- Administer medications rectally
Types of Enemas
Evacuation or Cleaning Enemas
Given to promote the elimination of feces, increase peristalsis, relieve constipation, cleanse, and prepare the intestines for radiographs, endoscopies, labor, and pre-operative procedures. Contraindicated in intestinal obstruction or abdominal trauma.
Classes of Evacuation Enemas:
- Soapy Water Enema: Warm water (37°C) with soap dissolved in it. The amount depends on the patient’s age and condition.
- Salt Enema: Warm water with 2 tablespoons of salt. Produces abdominal distention.
- Disposable Enemas: Made with hypertonic solution (sodium phosphate). Irritates the intestinal mucosa and causes direct distention.
Enema administration is performed with the patient in the Sims position (left side) with the right leg flexed.
Retention Enemas
Used to administer substances rectally and retain the liquid as long as possible.
Classes of Retention Enemas:
- Oleosol Enema: Lubricates and softens stool, facilitating evacuation. Composed of neutral olive oil, temperature 37-38°C, retained for approximately 1 hour. Indicated for patients with constipation, fecalomas, or hemorrhoids where defecation is painful.
- Medicamentous Enema: Contains drugs dissolved in a solution, absorbed by the rectal mucosa and incorporated into the bloodstream. Can be:
- Antihemetics: To eliminate parasites.
- Carminative: To expel accumulated gas in the colon.
- Antiseptics: To destroy microorganisms.
- Stimulants: To trigger intestinal activity.
- Emollient: To soften stools.
- Barium Enema: Introduction of a barium slurry (a radiopaque substance for X-rays) through a rectal probe to fill the large intestine for radiological studies.