My Colostomy Story

A repost from my blog.

Today, I had to deal with the dilemma of me being an experienced neurosurgery nurse, working in a general surgery unit. I worked in an ER and neurosurgery environment for the last seven years, and I knew that I would be faced to deal with some unfamiliar cases in a new work place.

I had a patient with a colostomy. Well, it may sound so simple for some general surgery nurses out there, but it was a big deal for me. It’s not that it was my first time, because I have had several patients with a colostomy. But it was my first time in several years to actually perform colostomy care – to actually touch and clean the stoma.

I was busy with another patient when I heard somebody screaming. When I looked out of my patient’s room, I saw one of my co-nurses coming out from one of my patient’s room. She asked me if the patient in room x is my patient, so I told him yes and asked her what’s wrong. She said the patient was complaining because he was yelling for an hour already and nobody is coming for him.

Since I was finished with my current patient, I decided to check the complaining patient out. I went to his room and I was welcomed with some more yelling. I asked him if he was pressing the bell since that is the proper way of calling a nurse. He said he did but it seemed the bell was not working.

I investigated further, and found out that the bell cord was not attached to the plug. So that was the reason nobody was coming to him. I was successful in trying to pacify him. I asked him what he needed and found out that his colostomy leaked up to his back. He said he was trying to open his colostomy because he felt it was full of air. When he opened it, he got surprised with the contents and everything leaked out and went to his clothes and sheets.

My patient had a colorectal cancer and the surgeons tried to remove the cancerous part of his large intestines. A new opening was made on the left side of his abdomen where his stool can come out, and will be drained to a pouch called colostomy bag.

I checked what I needed to clean him, and after that I told him I need to get some things in the stockroom. When I got into the stockroom, I took some fresh linens, pads, cleaning wipes and saline. To my horror, I found that there were different sizes of colostomy bag. How would I know which one is for my patient? I decided to just bring one from each of the different sizes. I thought it would be safe since I do not have to come back if one size fails.

When I went back to my patient’s room, I checked his colostomy so I could choose which size of bag I would need. To my surprise, none among those I brought were the same as my patient’s. I needed the biggest size which seemed not available because I did not find that size before. I knew I took one sample from each of the sizes I saw.

I went back to the stockroom and searched for the largest size. I did not find any, so I asked one of my seniors. He helped me search until he finally said it was probably out of stock.

I decided to go to another ward and asked for that size. I knew that every minute counts for my patient who was irritable initially. I found the size from another surgical unit and hurriedly went back to my patient.

When I got into my patient’s room, I was greeted by a frown. I explained to him why it took me a bit long to come back, that I needed to get his size from another unit. He seemed dissatisfied with my explanations, so I just tried my best to talk to him nicely.

I detached the old pouch from where it was connected. I placed it in the bathroom since I wanted to save the wire that closes the pouch at the end. I cleansed his stoma with normal saline. After cleaning, I tried to attach the new pouch to the connector. It seemed I could not connect it. It was either I was doing it the wrong way, or I just do not know what I was doing.

While I was trying to attach it, I tried to converse to him to try divert his attention from what I was doing. I explained to him some facts about colostomy, and how to take care of it. I was posing to be a pro with what I was doing, when deep inside, I knew I could not connect the bag. It was hurting him when I pressed harder on the pouch lid.

I then decided to ask help from a co-nurse. God probably heard my heart beating fast, and gave me a colleague just passing by my patient’s door! I asked her to help me attach the colostomy bag. She told me how to do it and watched me do it. It was the same technique as what I was doing before. But she also felt it was difficult doing it that way so she suggested for me to just remove the part that was attached to the skin, and apply a new one. The adhesive part that was touching the skin and the bag should already be connected before sticking it to the skin.

I actually thought of that, but I knew it was the harder way of changing the bag. But now, it seemed there was no other way but to do it that way.

I was successful in applying a new bag on him. I went back to the bathroom and took the wire from the old bag. It was heavily stained with stool so I just tried to clean it. I closed his colostomy bag using that wire.

I wiped him a bit, and brought him to the bathroom after that. I changed his gown and placed new linens on his bed. His mood has changed, and was apologetic about his attitude a while ago. I told him it was pretty understandable for him to get mad in his situation. I left him clean and satisfied with what I have done for him.

In the evening, before I left the unit, I checked him out in his room. He was with his family, and I was introduced to them. I told him that my shift is over and that I was leaving. He asked who’s replacing me, but I was not sure who’s taking care of him next. I saw in his face that he still wanted me to stay for him.

Before I left, he said smilingly “See you on Sunday!”.

(picture credit: butler.org)

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  • Anonymous

    Therapeutically Done! Congrats!

  • Earl

    One of the things that we're taught in nursing school is, ask if you're not sure what you're doing. This small principle is constantly overlooked because some of us feel we're incompetent. Certainly not and a good call on your part. It is assured that we will have days similar to this where you simply don't know what to do.

  • Anonymous

    the impt. thing is hindi ka nagpahalata and u were so cool about the whole incident..i know it takes a lot of patience to care our patients.more power to you…

  • Anonymous

    the sticky part that adheres to the patient's skin is called wafer..next time to save you precious time,check the pt's colostomy bag for the right size..

  • Anonymous

    My sympathy is largely with your patient but I'm glad it all worked out well for you both in the end — and hope you appreciate lessons learned. In 2010, management of a colostomy should not be considered foreign or complex.. Caring for ostomies, which include ileostomies and urostomies as well as colostomies, may be somewhat of a specialty but that care is quite easy to learn from an Enterostomal Therapy (ET) nurse or wound/care specialist. Many medical supply companies offer a variety of brands and sizes of supplies for ostomates. A good health facility has a responsibility to stock up on a diversity of these products to avoid this situation from recurring because ostomies are not rare. Also, it would help to learn the correct terminology, esp when communicating with a patient. That "wire" is a "clip" for the pouch which, in a 2-piece system, adheres to a wafer or flange that is placed on the abdomen. These days, often velcro closures eliminate the need for a clip — as you can see, much to learn. If the pouch is not emptied before it's — at most — 1/2 full, leakage may occur but this can be easily avoided with basic knowledge and having supplies on hand. (Your graphic shows a colostomy pouch that is quite full; these visuals are misleading and unhelpful.) For additional information, please see this URL: http://www.uoaa.org — the site for the United Ostomy Associations of America. You'll learn a great deal of important info about ostomies, products, suppliers, and procedures there. Consider attending a conference. Pls ask for add'l clarification if you need it — and share your awareness with others so that health providers and patients benefit.
    — A UOAA member.

  • Anonymous

    This is a very nice post and thank you for sharing your experience. I am a nursing student and I learned a lot about colostomies. It was not a very pleasant incident but you sure tried your best to ensure your patient's comfort. I am sure there will be times in my work when I wouldnt know what to do too, but by remaining calm and using common sense, I'll be able to complete my tasks.

  • Anonymous

    Hmmm… checked the picture out but I couldn't see that it's half full so how could the picture be misleading? Can't even see if there are any contents. For me, the image was quite helpful coz that made me understand what colostomies are all about. I worked in a unit where we get very seldom cases of colostomies and I couldn't remember the last time I cared for one. This is a very good review. And btw, I think you are a very good nurse. Checked your personal site too. Nice one. Kudos to you!

  • Anonymous

    You don't have to see the contents to tell the graphic shows a pouch that is very full, you can tell from the way it bulges out, an empty bag will be nearly flat. Really a bag shouldn't get more than 1/3 full. I have have had an ileostomy for nearly 6 years – I have no colon at all. You can find information on International Ostomy Association and links to ostomy associations in different countries at http://www.ostomyinternational.org. Other useful sites – http://www.ostomates.org, http://www.ostomycanada.ca, http://www.ostomyland.org.

    You can also find information aimed more at nurses at: http://www.wcetn.org – the World Council of Enterstomal Therapists.

  • Anonymous

    On behalf of ostomy patients around the world, I would like to thank you for going the distance to help that gentleman. I am an ostomate myself and I often hear a lot of bad expriences from my co-ostomates. But I am glad there are nurses like you who try their level best to ensure patient comfort and safety. God bless you!

  • funmilayo solomon-ogunjale

    Thanks for your experience, i have patient who uses colostomy bag, my patient can some times difficuit to the extend of just fidling with the bag because of her dimetia,what the team surgest is put a micro tape round it so she cant open it, it can also be confusing some times when sealing the bottom because they come in different seal.and thanks for your diagram.

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  • ron

    Hi Nelson, I am an ostomate. Can I grab your story and publish it in my newsletter for ostomates

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