NUR 14400
Colostomy Checklist
5/22/24
Standard
Met/Initials
Competency Areas
All procedures must include Pre- and Post-Protocols
Students are responsible for all content on the accompanying Information Sheet
Procedure Steps
Review patient’s medical history/medical record for indications for colostomy irrigation and type of
colostomy, contraindications to colostomy irrigation, medication use (such as anticoagulants), lab/other
diagnostic test results (such as x-rays), and allergies (use alternatives, as appropriate
When possible, assess impact of ostomy on self-image, self-care, sexual function/intimacy and
partner/caregiver. When possible, include patient and/or caregiver in procedure and promote self-image,
self-confidence, and self-care.
IRRIGATION OF OSTOMY
Irrigation should be performed at the same time every day. Irrigation is not indicated for every patient.
Perform hand hygiene. Put on nonsterile gloves and other personal protective equipment, as appropriate.
Help patient sit on toilet or on chair next to toilet or position in bed (high Fowler’s preferred).
Prepare irrigation fluid reservoir.
Clamp tubing.
Fill irrigation reservoir with required amount of warm tap water starting with 500 mL and increasing in
100 mL increments to maximum of 1,000 mL.
Release clamp.
Prime tubing with a small amount of fluid.
Reclamp tubing.
Hang irrigation bag (reservoir) on IV pole so bottom of reservoir is at shoulder height of seated patient.
Remove ostomy pouch or cover from skin barrier (if present). Discard pouch if soiled.
Lubricate gloved finger. Insert finger into stoma to determine direction of colon lumen.
Attach irrigation sleeve to ostomy skin barrier.
Place bottom of sleeve in toilet or commode. Do not allow sleeve to contact any part of toilet or toilet
water.
Discard gloves. Perform hand hygiene and put on nonsterile gloves.
Lubricate irrigation tip.
Gently but firmly insert tip into patient’s stoma. Do not force cone or insert it more than a small distance.
Angle cone to position of colon lumen.
Allow irrigation fluid to slowly enter colon for about 5-10 minutes.
If patient develops cramps, decrease flow rate. If cramps persist, stop procedure temporarily. After
cramps stop, slowly resume irrigation.
If signs/symptoms of bowel perforation develop or patient has a vasovagal reaction, immediately
stop irrigation, and notify health care provider (HCP). Do not leave patient unattended.
After all fluid has been instilled, hold tip in place for about 10 seconds. Then gently remove tip of cone.
Drain irrigation sleeve.
Let water and feces flow into sleeve, and from sleeve into toilet or commode, for 10-15 minutes.
Leave sleeve in place for another 30-45 minutes.
Once bowel has finished emptying into sleeve, remove sleeve and clean around stoma with wipes.
Discard disposable equipment in biohazard bag.
Replace with stoma cap, stoma plug, or another appliance.
Discard gloves and perform hand hygiene.
NUR 14400
Colostomy Checklist
5/22/24
REMOVING AND APPLYING COLOSTOMY APPLIANCE
If changing ostomy appliance, select a time of day when effluent is least likely to actively drain, such as
in early morning before eating or drinking.
Perform hand hygiene. Put on gloves and any additional personal protective equipment, as appropriate.
Use clean technique for ostomy care.
Position patient in a semi-reclining position, if possible.
Position mirror so patient can observe. Explain steps throughout procedure to enhance self-care ability.
Place a towel or disposable waterproof barrier across patient’s lower abdomen.
Observe pouch and barrier for leaking.
Empty reusable pouch if more than one-third to one-half full.
REMOVE APPLIANCE TO REPLACE APPLIANCE OR TO ASSESS SKIN.
Remove pouch from appliance (wafer).
Place gauze on stoma to absorb effluent while pouch is detached.
Assess characteristics and amount of effluent in pouch, then discard contents.
Gently push skin away from barrier to remove connected unit. Use adhesive remover, if necessary, to
avoid injuring or irritating skin.
Remove gloves and perform hand hygiene. Put on nonsterile gloves.
PROVIDE SKIN AND STOMA CARE.
Clean peristomal skin with washcloth and warm tap water. Do not scrub. Do not pick at small amounts of
residual paste if present. Gently pat skin dry.
Assess stoma appearance and peristomal skin condition using validated peristomal skin assessment tool.
Note peristomal skin soreness, redness, skin breaks, rash, maceration, or excoriation.
Identify and manage complications, as prescribed or recommended by ostomy care nurse specialist.
Remove gloves and perform hand hygiene. Put on nonsterile gloves.
Replace every 3-7 days, as recommended by the manufacturer, or if barrier is soiled, wet, loose, or
leaking.
APPLY NEW APPLIANCE
Measure stoma using ostomy measuring guide. Select circular size that fits around stoma with a 0.3 cm
(one-eighth inch) larger margin. Note: Stoma may expand within the first 6-8 weeks.
Trace pattern on pouch/skin barrier. Use scissors to cut appropriately sized opening in skin barrier to just
fit around stoma.
Warm skin barrier slightly with warmth of hands to make barrier slightly more pliable. Remove
protective backing from skin barrier. Apply over stoma and press firmly into place.
Smooth barrier around stoma from center outward. Run fingers around entire barrier to ensure a tight
seal.
Attach pouch to skin barrier (if using a 2-piece appliance) by interlocking pieces.
Tug gently to verify secure attachment.
Fold bottom tightly to close it. Use self-locking mechanism or tail clip, depending on type.
Remove gloves and perform hand hygiene.
Signature
Date
Evaluator's Signature
Date
ADAPTED FOR USE AT RCC BY THE RCC SKILLS LAB
Reviewer(s)
Debra Balderrama, RN, MSCIS, Clinical Informatics Services, Tujunga, CA
NUR 14400
Colostomy Checklist
5/22/24
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