Management of

stoma, catheter
and tubes
PRESENTED BY
LALITA KUMARI
MSc. NURSING 2ND YEAR
MANAGEMENT OF STOMA
INTRODUCTION
 Stoma is a Greek word meaning “mouth” or “opening”.

 A stoma is an opening in abdomen that allows to exist body, rather than

going through digestive system. They are when part of bowels or bladder
either need to heal or to be removed.
 There are three main types of stoma

1. colostomy
2. Ileostomy and
3. Urostomy
COLOSTOMY

 A colostomy is an artificial opening made in the large bowel to divert feces

and flatus to exterior, where it can be collected is an external appliance.
 Depending on the purpose for which the diversion has been necessary, a
colostomy may be:
1. Temporary
2. Permanent
TYPES OF COLOSTOMY

1. Loop colostomy
This type of colostomy is usually used in emergencies and is a temporary
and large stoma. A loop of the bowel is pulled out onto the abdomen he held
in place with an external device.
The bowel is then sutured to the abdomen and two opening are created in the
one stoma :one for stool and other for mucus.
a. Transverse colostomy
b. Sigmoid colostomy
2.End colostomy

 A stoma is created from one end of the bowel. The other portion of the
bowel is either removed or shut.
3. Double barrel colostomy

The bowel is severed (cut) and both ends are brought out onto abdomen.
Only the proximal stoma is functioning.
 Both ends of bowel are brought out.

 The proximal stoma (colostomy) diverts faces.

 The distal stoma-mucous fistula.

 Indication – trauma, tumours or inflammation

 Temporary or permanent.
ADVANTAGES :

 Ensure that the distal segment (colon, rectum) is completely definition

(absolute rest).
INDICAITONS FOR COLOSTOMY

1. A section of the colon has been removed, e.g. due to colon cancer
requiring a total mesorectal excision, diverticulitis, injury etc., so that it
is no longer possible for faeces to exit via the anus.
2. Faecal incontinence.
3. Inflammatory bowel disease.
4. Obstruction(blockage)
5. Cancer.
6. Injury.
7. Birth defects.
COMPLICATION OF COLOSTOMIES

There are five structural complications of colostomy

1. Retraction
2. Stenosis
3. Prolapse
4. Obstruction
5. herniation
2. ILEOSTOMY

 An ileostomy is a stoma constructed by bringing the end or loop of small

intestine (the ileum)out onto the surface of the skin, or the surgical
procedure which creates this opening.

INDICATIONS:
1. Ulcerative colitis
2. Crohn’s disease
3. Familial polyposis
4. cancer
3. UROSTOMY

 A urostomy is asurgical procedure that creates a stoma (artifical opening)

for the urinary system. A urostomy is made to avilable for urinary
diversion in cases where drainage of urine through the bladder and urethra
is not possible.
INDICATIONS

1. After cystectomy.
2. Bladder cancer.
3. Severe kidney disease.
4. Accidental damage or injury to the urinary tract.
5. Congenital defects that causes urine to back up into the
kidney.
COMPLICATION OF STOMA
1. Skin irritation.
This is a common problem that’s caused by the adhesive on ostomy
appliance. Try using a different appliance or changing the adhesive use.

2. Dehydration.
Having a lot of waste exist through stoma can lead to dehydration. In
most cases, rehydrate by drinking more fluids, but severe cases might require
hospitalization.

3. Leakage
If stoma appliance doesn’t fit properly, it can leak. If this happens
probably need a new appliance that fits better.
CONT..

4. Parastomal hernia
This is a frequent complication that happens when intestine starts to
press outward through the opening. These are very common and often go
away on their own. However, in some cases may need surgery to repair it.

5. Necrosis
Necrosis refers to tissue death, which happens when blood flow to stoma
is reduced or cut off.When this happens, it’s usually within the first few days
after surgery
STOMA CARE

Initial care
 Follow the steps below to promote wound healing.

 Observe colour of the stoma. Observe and document stoma for perfusion,

bleeding, skin integrity and signs of infection or prolapse every 4-6 hours.
 Measure stoma output. Notify medical staff if there is >30-49 mls/kg/day

stoma output.
 Ensure the skin surrounding the stoma is protected from excoriating effects

of enzymes
 Check stoma with cares 4 to 6 hourly for wound ooze, bleeding and bowel

motion.
POST OPERATIVELY

 Measure stoma and cut a hole in the flange of the Hollister new born
appliance to fit over the stoma, apply then put new born pouch onto skin
barrier. This should be done immediately post operatively for protection of
skin and stoma.
 In the first week post op the stoma will decrease in size as the swelling
removes, therefore the size of the hole cut in the flange will need re-
measuring (when new pouch applied.)
STABLILISING THE STOMA

 Follow the steps below to encure stoma is stablisied.

 Stoma pouch must be changed every 3-4 days, or as soon as it leaks.
 Check flange and pouch with cares, ensure flange is not leaking, if the
flange is stained underneath then it has leaked and needs to be changed.
Pouch needs to be emptied when 1/3 full of bowel motion or gas as it will
lift the flange.
 to change pouch if leaking.
 Gather equipment : gloves, bowl, warm water (no soap), gauze, cotton
buds, appropriate sized bag and clip, scissors, flange backing for size.
 Carefully remove old pouch from the top edge downloads , clean skin with
warm water, dry well; assess skin for any signs of excoriation. Assess
stoma for any changes in colour, sizes or excessive bleeding.
CONT..

 If skin is looking red, use the cavilon no string barrier film and allow to
dry.
 Cut hole in flange to fit the size and shape of stoma, the flange needs to fit
over the stoma with a gap of approximately 2mm from edge of stoma to
flange. If the flange is too close to the stoma will cause the flange to lift. If
the flange is not close enough to the stoma then the surrounding skin could
became excoriated.
 Warm flange between hands for approximately one minute. Apply flange
and apply pressure to flange for one minute and press down all edges.
Check the flange is well attached and apply pouch. Close end of pouch
with clip provided.
MANAGEMENT OF CATHETER
CATHETERS
INTRODUCTION
A catheter is a thin tube made from medical grade materials serving a
broad range of functions. Catheters are medical devices that can be inserted
in the body to treat diseases or performed a surgical procedure.

Catheter can be inserted into body cavity, duct, or vessels. Functionally,

they allow drainage, administration of fluids or gases, access by surgical
instruments, and also perform a wide variety of other tasks depending on the
type of catheter.
TYPES OF CATHETER
 Urinary catheter: a urinary catheter is used to drain the urinary when it
cannot be emptied normally.
 Indications:
 Short –term indwelling catheterization
 Collection of sterile urine sample.
 Provide relief of discomfort from bladder distension.
 Decompression of the bladder.
 Post surgery and in critically ill patients to monitor urinary output.
 Instillation of medication into the bladder.
 Acute urinary retention.
Intravenous catheter

These helps to give medicine or fluids straight into bloodstream. There are
three kinds:
a. Peripheral venous catheter
b. Midline peripheral catheter
c. Peripheral inserted central catheter

INDICATIONS
 Patient with limited peripheral access.

 Long –term IV medication administration.

 Blood product infusion.


CENTRAL VENOUS CATHETER

Central venous catheters as those that are inserted by the physician through a
vein in the neck, upper chest or anterior chest, with the tip in the vena cava of
the heart.

INDICATION
 Volume resuscitation

 Emergency venous access

 Nutritional support

 CVP monitoring

 Hemodialysis
A SWAN- GANZ CATHETER

 It is special type of catheter placed into pulmonary artery for measuring

pressure in the heart.

INDICATIONS
 Cardiogenic shock during supportive therapy

 Discordant right and left ventricular failure

COMPLICATION
Due to urinary catheter
 Infection

 Leaks

 Bladder spams

Related to intravenous catheters

 Get twisted

 Clotted blood might block catheter.

 Infection

 The catheter might come loose from the vein.

Central venous catheter

 The catheter might injure the vein

 The catheter might cut lung, would make it collapse.

CATHETER MANAGMENT

 Routine managemnet of urinary catheter

 Catheter size
 Minimizing infection
 Once the decision has been made to use an indwelling urinary catheter,
efforts should be made to minimize problems.
 The catheter should be inserted using sterile technique.
 Every attempt should be made to keep the drainage system closed. Any
break in the catheter-to-collection unit may invite earlier infection.
MANAGEMENT OF COMPLICATION

1. OBSTRUCTION:
The material that obstructs urinary catheter consists of bacteria, glycocalyx,
protein and precipitated crystal. Methylamine preparation may be beneficial
in reducing episodes of obstruction. Irrigation may present repeated
obstructions that are not responsive to increase fluid intake and urine
acidification. However obstructed catheter must be removed.

2. LEAKAGE:
bladder spasm are not uncommon in patients with long-term catheterization.
The force generated by spasms commonly overwhelms the drainage capacity
of the catheter, creating leakage around the catheter. This type of leakage
should not be corrected by using a large diameter catheter.
CONT..

 Infection or catheter obstruction, if present, should be treated.

Antispasmodics such as oxybutynin (Ditropan 2.5 to 5.0 mg four times
daily) and flavoxate (Urispas 100-200mg four times daily), can be
effective in alleviating spasm due to detrusor instability.

3. Colonization Vs Infection
 Virtually every patient with chronic catheterization is colonized with

bacteriuria within six weeks. Bacteriuria also occur within a few months in
the majority of patient using clean intermittent catheterization. Antibiotics
prophylaxis simply promotes emergence of antibiotic –resistance
microbes.
MANAGEMENT OF TUBES
TUBES

INTRODUCTION
Tube is along narrow object similar to a pipe that liquid or gas can move
through.
TYPES
1. Feeding tube
A feeding tube is a medical device used to provide nutrition to people who
cannot obtain nutrition by mouth, are unable to allow safely, or need
nutritional supplementation.

Types:
 Nasogastric tube
 Gastric or gastrostomy tube
 Jejunal tubes
INDICATION
 Less than 50% of necessary nutritional intake received orally for five days
 Coma
 Severe dysphasia
2. TRACHEAL TUBE
A tracheal tube is a catheter that is inserted into the trachea for the primary
purpose of establishing and maintain a patent airway and to ensure the
adequate exchange of oxygen and carbon dioxide.

INDICATION
◦ Upper air way obstruction
◦ Respiratory failure
◦ Head and neck surgery
◦ Removal of secretion
3. CHEST TUBE

 A chest tube ( chest drain, thoracic catheter, tube thoracotomy, or

intercostal drain) is a flexible plastic tube that is inserted through the chest
wall and into the pleural space or mediastinum. It is used to remove air
(pneumothorax), fluid, pleural effusion, blood or pus from the intrathoracic
space. It is also known as a Bulau drain or an intercostal catheter.
COMPLICATIONS OF TUBES

 Wound dehiscence
 Infection
 Leakage
 Aspiration
 Bleeding
 Accidental tube removal
 Tube blockage
 Tube fracture
 Tube displacement
 Aspiration pneumonia
CARE AND MANAGEMENT OF TUBES

 All artificial airway will be stabilized.

 The tracheostomy tube will be secured with Valero trach ties or cloths ties
at either side of neck except neurosurgery patients. When changing the ties
, the tracheostomy tube must be held in place to prevent extubation.
 The endotracheal tube will be firmly secure by a Hollister.
 For those patient that have an oral airway, repositioning should be done
every 4 hours with routine ventilator checks.
CONT..

 For neonatal and pediatric patients, tubes will be repositioned as necessary

or re-taping the endotracheal is required.

 Except the emergencies, generally physician is the only one who changes

the tracheostomy tube until patient firmly teaching begins. At that times a

respiratory therapist may instruct in changing the tube.

 A patient with oral endotracheal tube may have an oral airway or bite

block in place that should be change at leas every 24 hours.

Cont.

 A ventilator. T- tube , or trach collar will provide constant humidification.

Corrugated tubing should be emptied by disconnecting the tubing and

draining into an appropriate receptacle.

 An extra tracheostomy tube of the same size is to be kept at the bedside at

all times. In pediatric area, tube of the same size and size and size down is

required to b at beside at all times.