MANAGEMENT OF CHILD WITH STOMA, CATHETERS, AND

TUBINGS

Stoma care
Stoma formation in childhood is performed during the surgical correction of congenital
abnormalities, following trauma and/or to defunction the bowel, treatment of inflammatory
bowel disease, intestinal motility disorders, infections e.g. necrotising enterocolitis and
malignancy of gastrointestinal tract or urinary system.

There are three main types of output stomas:

 Ileostomy: a portion of ileum is brought out through the abdominal wall and is normally
sited in the right iliac fossa.
 Colostomy: a portion of the colon is brought through the abdominal wall and is normally
sited in the left iliac fossa (the transverse, descending or sigmoid colon may be used).
 Urinary diversion:

 Vesicostomy: the neck of the bladder is brought through the abdominal wall low
down in the pelvis.

 Ureterostomy: one or two of the ureters can be brought out to the abdominal wall
either side by side or at either side of the abdomen or flanks.

 Ileal conduit: a small segment of ileum is isolated to act as a reservoir and the
ureters implanted into it. This stoma can be sited either in the left or right iliac
fossa. 

There are many different pouches produced by a number of manufacturers. Using an

inappropriate pouch is time-consuming and can cause needless discomfort for the child.

There are basically two designs of pouch:

 A one-piece pouch has an adhesive flange with a pouch bonded onto it.
 A two-piece pouch has an adhesive flange and a separate pouch, which attaches to the
flange. 

 Both the one piece and the two-piece pouch can have a closed end or an open or
drainable end.
 Urinary pouches have non-refluxing valves and an adaptor to attach to an overnight
drainage bag
Children with colostomies, which produce formed stool, have the opportunity to use a colostomy
plug:

 A faceplate is attached to the skin and a plug is inserted into the stoma. A cap on the end
of the plug is then clipped onto the faceplate.
 The plug has to be removed at least twelve hourly and a bag attached to the faceplate

In the early post-operative period a one piece, drainable transparent pouch should be applied.

Skin care
 The skin around the stoma is called the peristomal skin and it is just the same as other
skin on your child's body. It is not more or less sensitive. Although the stoma has no
feeling, the skin does.
 One of the most important goals is to keep the skin healthy. If the skin does not stay
healthy, problems with pouch leaking may occur.
 To clean the skin around the ostomy, use just water. Or we can use a mild soap that does
not leave a film or residue on the skin, then rinse with plain water. Always rinse off any
soap. Soap or water will not hurt the stoma.
 Do not use any baby wipes, oils, powders, ointments, lotions on the skin around the
stoma. These products contain ingredients that can prevent the pouching system from
sticking.

 For a preterm infant, the baby's skin has not yet had the chance to develop and mature.
For that reason, we will have to take extra care with all products used on the newborn's
skin. Gentle products, such as SoftFlex skin barriers from Hollister, are designed to
prevent tearing. Because substances can be absorbed through immature skin.

 The skin should not be irritated as this can be uncomfortable for child. Open areas, a
persistent redness or red bumps on the skin are not normal. It is essential to determine the
cause and treat it appropriately.

Stoma siting 
The majority of stoma formation in childhood is carried out in the neonatal period. Stomas are
generally a temporary measure until definitive surgery is performed. Babies do not have their
stomas sited as they are formed during an emergency surgery.

Time and consideration should be spent ensuring the optimal site is marked. The following
points should be considered:

 The child should be able to see the stoma.

  The stoma should be placed within the rectus abdominus sheath.
 Any bony prominences must be avoided
 Any previous scars, skin folds or creases must be avoided. There should be enough flat
surface around the stoma for the pouch to adhere
 The waistline of clothes must be avoided
 Ensure that any prostheses or braces do not cover the site
 If the child is wheelchair bound, the stoma must be sited while he/she is in the wheelchair

Changing the stoma pouch 

 Gather appropriate equipment:
o receptacle to empty the pouch into
o disposable gloves (for hospital staff)
o non-alcoholic adhesive remover
o bowl of warm water
o gauze squares or cleansing wipes
o new pouch
o bag to dispose of the used pouch and cleansing materials
o scissors
o template or measuring device
 Position the child. Babies should lie down, older children may lie down or stand up
 Wash hands and put on disposable gloves. If a drainable pouch is used it needs to be
emptied prior to removal.
 The output should be measured, with volume and consistency documented on fluid chart.
 Remove the old pouch by carefully peeling it off from top to bottom with one hand,
whilst supporting the skin with the other. Only use non-alcoholic adhesive removers if
required - adhesive removers with alcohol should not be used on small babies 
 The old pouch should be disposed of in an orange clinical waste bag.
 Clean the peristomal skin with warm water and gauze. If some residue is left on the skin
from the old pouch, use a dry piece of gauze to remove it before washing. Do not use
cotton wool. Ensure the skin is dried thoroughly
 Prepare the new pouch. The aperture should be cut to fit snugly around the stoma with no
peristomal skin exposed. A template or measuring device can be used for this.
 Put on the new pouch. 
 If a one-piece pouch is being used, fold the adhesive backwards in half, placing the pouch
on the underside of the stoma first, then flip the adhesive over the stoma and secure all
around.

Diet and nutrition

 A well-balanced diet is important for everyone. Many parents wonder if their child will
have dietary restrictions because of the ostomy. In general, a “special” diet may be
necessary due to other medical conditions but not because of the stoma.
  Breastfeeding offers many advantages for both baby and mom. It is our choice. If the
baby is in the Neonatal Intensive Care Unit (NICU), we may need to use a breast pump
and save milk until the infant can be fed.
 A person who specializes in helping breastfeeding moms is called a Lactation Consultant
(LC). The mothers may want to ask the nurses in the NICU if there is an LC available.
 New foods can be added to baby's diet as recommended by their Physician. When a new
food is added, it may change the color or Consistency of child's stool or may result in
more gas. This is normal. Watch how they react to any new food. If it causes a problem
with their output, consult the child's doctor.
 Gas is a common concern - especially with colostomies. Gas in the pouch can be due to
swallowed air when the infant sucks. In an older child, gas can come from food,
carbonated beverages, using a straw or chewing gum.
 Children who have ileostomies may have a few additional guidelines. Some foods do not
digest well and therefore may not pass through the ileostomy stoma.Pediatric nurse or a
dietician in the hospital can help to identify these foods. To avoid problems, they may
recommend limiting or omitting specific foods. Older children may be allowed these
foods if they chew thoroughly before swallowing.
 If there is no output from the stoma for a prolonged period and child Experiences
cramping, diarrhea or bloating, call your child's doctor. Fluid intake is important for all
children. Infants and children with Ileostomies can quickly become dehydrated.

 Potential problems with stomas 

There can be problems with stoma management in pediatric patients. In the post-operative period
a drainable transparent pouch is used so that the stoma can be observed easily, the main
observation should be the colour of the stoma. Any concerns should be reported and recorded in
the patient's notes.

Colour

A healthy stoma is red/pink in colour. It is very important, especially in the postoperative period,
to check the colour of the stoma regularly. If the stoma appears darker in colour medical advice
should be sought.

Oedema

In the early postoperative period all stomas will be oedematous. Parents and children should be
aware that the stoma will change shape and size. At six weeks the stoma should have shrunk to
its actual size. This is important as the parent/child needs to cut the pouch or flange to the exact
size of the stoma.

Prolapse
Prolapse of loop stomas in infants and children is common. Parents and children need to be
advised of the possibility, given a description of what a prolapse looks like, and when to seek
medical advice. Older children should be discouraged from lifting heavy weights.

Retraction

Some stomas can become retracted. This will cause more problems with an ileostomy as the
output is loose, and stool will leak under the adhesive of the pouch. Parents can seek the advice
of the stoma nurse or the doctor if the stoma appears sunken.

Stenosis

Stenosis of the stoma can also occur. Often the narrowing of the bowel is at the skin surface, but
it can occur inside the abdomen. This may present with:

 a reduction in the amount of stool passed

 stools may appear ribbon-like
 the passage of stools may cease

Granuloma

Nodules of granulation tissue can form on the surface of the stoma. These can bleed easily and
may cause concern, as they will bleed whenever the stoma pouch is changed.

 Management of chest drainage tubing’s:

Start of shift checks

 child assessment
 Chest drain assessment
 Equipment
 Ensure that Chest Drain is recorded
 Other considerations e.g physiotherapy referral

Assessment
 Vital signs
o PICU and NICU children’s should be on continuous monitoring
o HR, SpO2, BP, RR
o Routine observations:
 For ward areas: 
o On insertion of chest drain monitor patient observations of HR, SpO2, BP, RR: 
  15 minutely for 1 hour
 1 hourly for 4 hours
o Includes HR, SpO2, BP, RR, Respiratory Effort and temperature
o 1-4 hourly as indicated by patient condition
o Observations to be recorded in the Observation Flowsheet on EMR

Pain
 Chest tubes are painful as the parietal pleura is very sensitive. Children’s require regular
pain relief for comfort.
 Pain assessment should be conducted frequently and documented.

Drain insertion site

 Observe for signs of infection and inflammation and document findings in EMR
 Check dressing is clean and intact
 Observe sutures remain intact and secure (particularly long term drains where sutures
may erode over time)

UWSD Unit and tubing

 Never lift drain above chest level

 The unit and all tubing should be below patient’s chest level to facilitate drainage
 Tubing should have no kinks or obstructions that may inhibit drainage
 Ensure all connections between chest tubes and drainage unit are tight and secure 
 Connections should have cable ties in place
 Tubing should be anchored to the patient’s skin to prevent pulling of the drain
 In PICU and NICU tubing should also be secured to patient bed to prevent accidental
removal
 Ensure the unit is securely positioned on its stand or hanging on the bed
 Ensure the water seal is maintained at 2cm at all times.

Suction
 Suction is not always required, and may lead to tissue trauma and prolongation of an air
leak in some patients
 If suction is required orders should be written by medical staff
o Atrium Oasis- The wall suction should be set at >80mmHg or higher
o Atrium Ocean- Suction needs to be titrated so that the fluid in suction chamber is
gently bubbling
 Suction on the Drainage unit should be set to the prescribed level
o -5 cmH20 is commonly used for neonates
o -10 cmH20 to -20 cmH20 is usually used by convention for children
  To check suction:
o Any visible expansion of the bellows is adequate for suction <20 cmH20
o If the bellows deflate, check the wall suction is still working, set to > 80mmHg
and that the suction tubing is not kinked
 Atrium Ocean UWSD:
o The water level in the suction chamber should be at prescribed level and gentle
bubbling should be observe
o The level may drop due to evaporation or over-vigorous bubbling, if this occurs
top fluid level up as per manufacturer’s instructions

Drainage
 Milking of chest drains is only to be done with written orders from phusician. Milking
drains creates a high negative pressure that can cause pain, tissue trauma and bleeding
 Volume
o Document hourly the amount of fluid in the drainage chamber in the Fluid
Balance flowsheet on EMR
o Calculate and document total hourly output if multiple drains
o Calculate and document cumulative total output
o Greater than 5mls/kg in 1 hour
o Greater than 3mls/kg consistently for 3 hours
o Blocked drains are a major concern for cardiac surgical patients due to the risk of
cardiac tamponade
o Notify medical staff if a drain with ongoing loss suddenly stops draining
o If the chamber tips over and blood has spilt into next chamber, simply tip the
chamber up to allow blood to flow to original chamber

Air Leak (bubbling)

 An air leak will be characterised by intermittent bubbling in the water seal chamber when
the child with a pneumothorax exhales or coughs
 Continuous bubbling of this chamber indicates large air leak between the drain and the
child. Check drain for disconnection, dislodgement and loose connection, and assess
child’s condition. Notify medical staff immediately if problem cannot be remedied.
 Document on Fluid Balance Flowsheet on EMR

Oscillation (swing)
 The water in the water seal chamber will rise and fall (swing) with respirations. This will
diminish as the pneumothorax resolves.
 Watch for unexpected cessation of swing as this may indicate the tube is blocked or
kinked
 Cardiac surgical patients may have some of their drains in the mediastinum in which case
there will be no swing in the water seal chamber.
  Document on Fluid Balance Flowsheet on EMR 

Equipment by the bedside

 Drain Clamps: At least 2 drain clamps per drain
 For use in emergency only e.g. accidental disconnection
 Two suction outlets: One for chest drain and one for airway management

Positioning
 who are ambulant post operatively will have fewer complications and shorter lengths of
stay. Consider converting to a portable flutter valve system such as the pneumostat to
facilitate this. If chest drain will be required for prolonged period
 if patient is an infant, regular changes in position should be encouraged to promote
drainage, unless clinical condition prevents doing so

Patient Transport
 If the patient needs to be transferred to another department or is ambulant, the suction
should be disconnected and left open to air.
 do not clamp the tube
 Clamps must not be used on the patient for transport because of the risk of tension
pneumothorax
 Ensure the chamber is below the patient’s chest level during transport
 Flutter Valve systems (pneumostat, Heimlich) may be used for patient interhospital
transfers (e.g. NETS and PETS)

Specimen Collection
Collect drainage specimens for culture through the needless sampling port located by the in line
connector.

Equipment Required

 Specimen container
 Alcohol swab
 10ml syringe
 Dressing pack
 Gloves
 Eye Protection

Procedure:

1. Wait for the fluid to collect in a loop of the tubing

 2. Perform hand hygiene, then don gloves & eye protection
3. Clean the sampling port, or for smaller sampling volumes you can use the patient tube,
with an alcohol wipe and leave to dry for 20 seconds
4. Clamp the tubing above where the fluid has collecte
5. Connect a 10ml Luer lock syringe to the sampling port and aspirate the fluid out of the
tubing. If using the patient tube clamp the tubing then use a 20 gauge needle with syringe
to aspirate specimen.
6. Place fluid in sterile specimen container
7. Once the syringe is disconnected remove all clamps and kinks
8. Perform hand hygiene 

Chest Drain Dressings

Dressings should be changed if:

 no longer dry and intact, or signs of infection e.g. redness, swelling, exudate
 Infected drain sites require daily changing, or when wet or soiled
 No evidence for routine dressing change after 3 or 7 days
 This procedure is a risk for accidental drain removal so avoid unnecessary dressing
changes

For all other chest drains:

 Sandwich between occlusive dressing

o Allows site visibility and prevents pressure on skin
 If site oozing dress with split gauze and occlusive dressing

Ensure drain is secure

 To prevent it falling out use a 'tag' of tape to secure to skin

 Use a securement device such as a grip-lockTM to secure the drains to the skin

Removal of Dressings
 To remove dressing when placed flat against the skin
o Lift corner from the skin and slowly stretch the in dressing in a motion that is
parallel to the skin
 To remove semi permeable dressing placed in a sandwich position
o Hold the corners of the dressing on either side of the drain and pull them away
from each other; this should create a pocket around the drain
 o Peel each of the dressings away from each other until we reach child’s skin
o Slowly stretch the rest of the pressing in a motion that is parallel to the skin to
remove the rest of the dressing.

Changing the Chamber

 Indications
o The chest drain chamber needs to be replaced when it is ¾ full or when the
UWSD system sterility has been compromised eg. Accidental disconnection.
 Equipment Required
o New UWSD
o Dressing pack
o Gloves
o Eye Protection

Procedure

1. Perform hand hygiene

2. Use personal protective equipment to protect from possible body fluid exposure
3. Using an aseptic technique, remove the unit from packaging and place adjacent to old
chamber
4. Prepare the new UWSD as per manufacturer’s directions supplied with drain
5. Ensure patients drain is clamped to prevent air being sucked back into chest
6. Disconnect old chamber by holding down the clip on the in line connector to pull the
tubing away from the chamber.
7. Insert the tubing into the new chamber until you hear it click.
8. Unclamp the chest drain
9. Check drain is back on suction
10. Place old chamber into yellow infectious waste bag and tie
11. Perform hand hygiene

Splitting the UWSD Chambers

 Indications
o When 2 chest drains are connected via a Y-connector into 1 drainage chamber
there may be a need to have them split into 2 chambers to determine if 1 drain is
draining more than the other
 Equipment Required
o New UWSD
o Dressing pack
o Gloves
o Eye Protection
o Chlorhexidine
o Scissors
 o Connector
o Cable tie wraps
o Cable tie gun

Procedure

1. See Aseptic Technique Policy and Procedure 

2. Perform hand hygiene
3. Use personal protective equipment to protect from possible body fluid exposure
4. Place newly prepared drainage system in a position adjacent to the old system as set up as
per chest drain set up.
5. Clamp all tubing
6. Cut the tie wraps with the Pliers
7. Remove the Y connector and attached tubing
8. Clean ends of exposed drains And wait 20 seconds
9. Attach drainage system to chest drain
10. Repeat with second chamber
11. Place tie wraps around connection site and pull to tighten
12. Tighten further using Cable tie Gun
13. Once secure remove clamps and check for signs suction has returned

Removal of Chest Drains

There must be a written order by medical staff in EMR

Indications

 Absence of an air leak (pneumothorax)

 Drainage diminishes to little or nothing
 No evidence of respiratory compromise
 Chest x-ray showing lung re-expansion

Equipment required

 Dressing trolley with Yellow Infectious waste bag attached

 Dressing pack (sterile towel, sterile gauze)
 Sterile Gloves
 Steristrips
 Suture Cutter
 Band Aids
 Normal Saline
 Clamps
 Eye Protection
  Occlusive dressing
 Sharps container
 Appropriate skin cleaning solution for procedure
o Neonates <1500 grams- Chlorhexidine irrigation solution 0.1% (Blue Solution)
o For all other patients- Aqueous Chlorhexidine 0.15% w/v cetrimide 15% (Yellow
Solution)

Procedure

1. Perform hand hygiene

2. Opening dressing pack and add sterile equipment and 0.9% saline
3. Don disposable gloves
4. Remove all dressings around the area
5. Clamp drain tubing
6. If there are multiple drains insitu, clamp all drains before removal. Once the required
drains are removed, unclamp remaining drains
7. Remove disposable gloves, perform hand hygiene and don sterile gloves
8. Place sterile towel under tubes
9. Clean around catheter insertion site and 1-2cm of the tubing with age appropriate skin
cleaning solution
10. If purse string present (cardiac patients) unwind in preparation for assistant to tie
11. Remove suture securing drain (ensuring purse string suture not cut)
12. Instruct patient exhale and hold if they are old enough to cooperate; if not, time removal
with exhalation as best as possible.
13. Pinching the edges of the skin together, remove the drain using smooth, but fast,
continuous traction.
14. The assistant pulls purse string suture closed as soon as the drain is removed, tying 2
knots and ensuring the suture is not pulled too tight. Cut tails of suture about 2cm from
knot
15. If there is no purse string present remove drain and quickly seal hole with occlusive
dressing
16. Instruct patient to breathe normally again
17. Apply occlusive dressing (bandaid for cardiac children) over site
18. Remove and discard equipment into a yellow infectious waste bag and tie
19. Perform hand hygiene

Post Procedure Care

 Attend to patients comfort and sedation score as per procedural sedation guideline
 CXR should be performed post drain removal
 Patients in PICU may wait until routine daily CXR if clinically well
 Clinical status is the best indicator of reaccumulation of air or fluid. CXR should be
performed if patient condition deteriorates
 Monitor vital signs closely (HR, SpO2, RR and BP) on removal and then every hour for 4
hours post removal, and then as per clinical condition
 Document the removal of drain in the LDA flowsheet in EMR
  Remove sutures 5 days post drain removal
 Dressing to remain insitu for 24 hours post removal unless contaminated
 Complications post drain removal include pneumothorax, bleeding and infection of the
drain site

 Complications and Troubleshooting

Pneumothorax
 Signs and symptoms include: Decreased SpO2, increased WOB, diminished breath
sounds, decreased chest movement, complaints of chest pain, tachycardia or bradycardia,
hypotension
 Notify medical staff
 Request urgent CXR
 Ensure drain system is intact with no leaks, or blockages such as kinks or clamps
 Prepare for insertion/ repositioning of chest  drain

Infection of insertion site

 Notify medical staff
 Swab wound site
 Consider blood cultures

Accidental disconnection of system

 Clamp the drain tubing at the patient end. Clean ends of drain and reconnect. Ensure all
connections are cable tied. If a new drainage system is needed cover the exposed patient
end of the drain with sterile dressing while new drain is setup. Ensure clamp removed
when problem resolved
 Check vital signs
 Alert medical staff

Accidental drain removal

 Apply pressure to the exit site and seal with steri-strips. Place an occlusive dressing over
the top
 Check vital signs
 Alert medical staff.
 A VHIMS must be completed by the patient nurse.

Purse string cut or not present

  Small bore drains such as pigtails do not require purse strings. Simply apply an occlusive
dressing.
 For large bore drains:
 Pinch or apply pressure to the exit site
 Apply steri-strips to close exit site and cover with an occlusive dressing
 Notify the responsible medical team to review patient and consider need for a suture
 A VHIMS must be completed by the nurse delegated to remove the drain.

Unable to remove chest drain

 If the drain is unable to be removed with reasonable traction being applied, notify the
responsible medical team.

Retained drain during removal

 If the tube fractures during drain removal and remnants of the tubing is left within the
patient contact the treating team
 A chest x-ray should be conducted as soon as possible.
 The patient should be prepared for theatre
 The whole drain unit should be kept in the patient’s room until surgical review and will
need to be kept for collection to enable quality review.
 The piece of drain tubing that remains in the patient will also be kept once surgically
removed to allow for appropriate follow up of the incidents cause.

Family Centered Care

 Explain purpose of chest drain to family and when it is likely to be removed
 Discuss the need for pain relief for the child to be comfortable enough to move and
participate in physiotherapy

 Management of child with catheters:

 Measure urine output as indicated 1 – 4 hourly and assess the colour and concentration of
urine output.
 Unless otherwise specified by the treating team, normal pediatric urine output is 1-
2ml/kg/hr. Report any variation from this to the treating medical team. 
o Certain drugs will increase diuresis, such as diuretics and ACE inhibitors.
o If oliguric ensure catheter is not blocked.
o Record fluid balance. A fluid balance which keeps the urine dilute will lessen the
risk of infection. This may not be possible due to the clinical condition of the
child.
  The IDC insertion site and securement should be assessed at least once a shift, to ensure
the IDC is not pulling on the genitals and not twisted. 
 IDC drainage bags should be emptied once a shift at a minimum. 
 Position drainage bag to prevent backflow of urine or contact with the floor. Gravity is
important for drainage and prevention of urine backflow. Ensure the drainage bag is
below the level of the bladder, is not kinked or twisted and is secured.

Drainage system
 Adherence to a sterile continuously closed method of urinary drainage has been shown to
markedly reduce the risk of acquiring a catheter associated infection. Therefore breaches
to the closed system should be avoided.
 Consider changing the catheter tube and/or bag based on clinical indicators including
infection, contamination, obstruction or if system disconnects, if the equipment is
damaged or leaks. Replace system and/or catheter using aseptic technique and sterile
equipment.

Hygiene

 Routine hygiene should be maintained with routine bathing/showering, including daily

clean IDC insertion site with warm soapy water and more frequently if build-up of
secretions is evident.
 Uncircumcised boys should have the foreskin gently eased down over the catheter after
cleaning.

Infection surveillance

 Consider daily the need for the IDC to remain in situ. Remove as soon as no longer
required to reduce risk of Urinary Tract Infection (UTI).
 Cloudy, offensive smelling or unexplained blood stained urine is not normal and needs
further investigation.

Assessment:

 Catheter not draining/ blocked/patient oliguric

 Check catheter/tubing not kinked
 Check catheter is still secured to patient leg and that it  hasn't migrated out of bladder
 Assess patient’s hydration status to ensure they are not dehydrated. Consider the need to
perform a bladder scan to assess bladder volume. Escalate to medical team if concerned.
 The patency of a catheter can be checked via the sampling port or catheter tubing. A
blocked catheter should be flushed via the catheter tubing, this is of particular importance
in case of blood clots or mucus (for example after a bladder augment). 

Catheter leaking
  Ensure the catheter is still draining and that the urine is not overflowing around a blocked
catheter. See above for tips regarding catheters not draining.
 Make sure the balloon is still inflated. Hold the catheter tubing securely in the same
position and empty the balloon to make sure the amount that has been placed initially in
the balloon is still present. If not, reinflate the balloon to its initial volume with water.
Deflation of the balloon happens easily with a 6Fr catheter.
 Check catheter size is correct for age/size of the child. Use of a balloon catheter in
neonates should only be with consultation with the treating medical team.
 Consider the need to remove and reinsert a new catheter in consultation with the treating
medical team. 

Removal of urinary catheter 

 Explain procedure to child and family.

 Perform hand hygiene & don gloves.
 Deflate balloon completely.
 Gently withdraw catheter, with rotation movements if necessary.
o Bear in mind that once inflated, the balloon won’t deflate to its total initial flat state and the
balloon portion of the catheter will remain larger than the catheter itself.
 If resistance felt and catheter cannot be easily removed do not force, leave catheter in situ
and consult medical team. 
 Consider cutting the catheter at the balloon inflation point to ensure the balloon is deflated. 
 Once removed inspect catheter for intactness. Report if not intact.
 Perform hand hygiene.
 Document catheter removal in the LDA activity.
 Observe for urine output post catheter removal.
 If the patient has not passed urine 6 – 8hours post catheter removal assess the patient’s
hydration status and consider the need to perform a bladder scan. Discuss findings with the
treating medical team. 

Discharge information
Some children will be discharged from the hospital with their IDC in situ.
It is important to teach the families how to care for the catheter, how to perform hygiene, how to
monitor the output and how to troubleshoot.
Discuss the following with the child and family:

 Assess the catheter insertion site at least once per day.

 Clean the site of insertion once per day if accessible with warm soapy water when attending
to their normal bath or shower.
 Regularly check the tubing is not kinked or leaking, if any concerns contact the treating
team. 
 The family should have enough supplies to take home to last until they return for removal of
the catheter or until their supplies organised with stomal therapy department have
commenced. This includes leg bags, overnight bag and securement devices.
 In the home each catheter bag can last up to a week. If using leg bags and overnight bags
when they are swapped over rinse the bag through with warm soapy water and allow to air
dry.

Complications
 Inability to catheterize: ensure appropriate catheter size has been selected based on the
age/size of the child. Ensure adequate procedural pain relief and distraction is in place
during the procedure.
o Escalate to the treating medical team and consider the need for a referral to the
urology team. 
o In young girls, the urethra can be difficult to localize and the catheter can go
directly in the vagina. In this case, leave the first catheter in the vagina and use
another one to place immediately above, which will be more likely to go in the
urethra.
 False passage (catheter pushed through urethral wall): The risk of false passage is
actually higher when using a smaller catheters, ensure catheter size utilised is appropriate
for child’s age and size.
 Urethral strictures following damage to urethra. This may be a long term problem
 Infection
o To minimize risk of infection insertion of IDC’s must be performed using surgical
aseptic technique with single use sterile gloves. 
o Regular hygiene should be maintained whilst IDC is in situ. 
o Where possible avoid disconnecting the IDC circuit to minimise risk of
contamination
o Monitor for and report signs of infection including fever, offensive smelling
urine, unexplained blood or cloudy urine.
 Psychological trauma
 Paraphimosis due to failure to return foreskin to normal position following catheter
insertion:
o To minimise risk remember to replace the foreskin in non-circumcised patients
and check at catheter care or nappy change that the foreskin is in place.
 HOLY FAMILY COLLEGE OF NURSING

ASSIGNMENT ON
MANAGEMENT OF CHILD
WITH STOMA, CATHETER
AND TUBINGS
Submitted to: Mrs. Jibanlata Submitted by: Tanvi Kundra
Associate Professor M.sc Nursing 2nd year
HFCON HFCON