Irrigating a Colostomy

EQUIPMENT
Reservoir for irrigating fluids; irrigator bag or enema bag if irrigator bag not
available
Irrigating fluid: 500-1,500 mL lukewarm water or other solution prescribed by
health care provider (Volume is titrated based on patient tolerance and
results; average amount is 1,000 mL.)

Irrigating tip: Cone tip or soft rubber catheter #22 or #24 with shield to
prevent backflow of irrigating solution (Use only if cone not available. The
cone is the preferred method to avoid possibility of bowel perforation.)

Irrigation sleeve (long, large-capacity bag with opening at top to insert cone
or catheter into stoma); available in different styles: Snap-on, self-adhering
to skin, or held in place by belt
Large tail closure
Water-soluble lubricant

PROCEDURE
Nursing Action Rationale
Preparatory phase
1 Explain the details of the procedure to the 1 Relieves anxiety and
. patient and answer any questions. . promotes compliance.
2 Select a consistent time, free from 2 Establishes regularity.
. distractions. If the patient is learning to .
irrigate for bowel control, choose the time of
day that will best fit into the patient's
lifestyle.
3 Have the patient sit in front of the commode
. on chair or on the commode itself, providing
privacy, and comfort.
4 Hang irrigating reservoir with prescribed 4 Height of irrigation bag
. solution so the bottom of the reservoir is . regulates pressure of
approximately at the level of the patient's irrigant.
shoulder and above the stoma.
Note: Colostomy irrigation may also be
performed to empty the colon of its contents
(feces, gas, mucus) before a diagnostic
procedure or surgery and to cleanse the colon
after fecal impaction removal or with
constipation.

Performance phase
1 Remove pouch or covering from stoma, and 1 Allows water and feces to
. apply irrigation sleeve, directing the open tail . flow directly into commode.
 into the commode.
2 Open tubing clamp on the irrigating reservoir 2 Removes air from the setup;
. to release a small amount of solution into the . avoids air from being
commode. introduced into the colon,
which can cause crampy
pain.
3 Lubricate the tip of the cone/catheter, and 3 Prevents intestinal
. gently insert into the stoma. Insert catheter . perforation and irritation of
no more than 3 inches (7.5 cm). Hold mucous membranes.
cone/shield gently, but firmly, against stoma
to prevent backflow of water.
4 If catheter does not advance easily, allow 4 Slow rate relaxes bowel to
. water to flow slowly while advancing catheter.. facilitate passage of
NEVER FORCE CATHETER. Dilating the stoma catheter.
with lubricated, gloved pinky finger may be
necessary to direct cone/catheter properly.
5 Allow water to enter colon slowly over a 5- to 5 Cramping may occur from
. 10-minute period. If cramping occurs, slow . too rapid flow, cold water,
flow rate or clamp tubing to allow cramping excess solution, or colon
to subside. If cramping does not subside, ready to function.
remove cone/catheter to release contents.
6 Hold cone/shield in place 10 seconds after 6 Discourages premature
. water is instilled, then gently remove . evacuation of fluid.
cone/catheter from stoma.
7 As feces and water flow down sleeve,
. periodically rinse sleeve with water. Allow 10-
15 minutes for most of the returns, then dry
sleeve tail and apply tail closure.
8 Leave sleeve in place for approximately 20 8 Ambulation stimulates
. more minutes while patient gets up and . peristalsis and completion
moves around. of irrigation return.
9 When returns are complete, clean stomal 9 Cleanliness and dryness
. area with mild soap and water; pat dry; . promote comfort.
reapply pouch or covering over stoma.

Follow-up phase
1 Clean equipment with soap and water; dry 1 This will control odor and
. and store in well-ventilated area. . mildew, prolonging the life
of equipment.
2 If applicable, the patient should use a pouch 2 It may take several months
. until the colostomy is sufficiently controlled. . to establish control. The
patient can then use
minipouch, stoma cap, or
gauze covering as desired.