HINT: How to perform a stoma assessment on children with ostomies in home and community?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
HINT: How to perform a stoma assessment on children with ostomies in home and community?
SITUATION:
This QuickHit was informed by Connected Care’s recent expansion of services to include ostomy education for family caregivers and home and community care providers and new resources on AboutKidsHealth.
BACKGROUND:
Children with medical complexity may have ostomies to help get rid of stool or urine if their intestine or urinary tract does not work properly. An ostomy is an opening from the inside of the body to the outside, through the abdomen. It is created during surgery and can be temporary or permanent depending on the child’s medical condition and needs.
The end of the ostomy is called the stoma. Stool or urine exits the body from the stoma and is collected outside the body in a bag called an ostomy pouch. A stoma and ostomy pouch are demonstrated in the image below.
ASSESSMENT:
Ostomies have different names depending on where they are located, including ileostomies, colostomies and urostomies.
Ileostomy: creates an opening from the last part of the small intestine (the ileum) to the abdomen
Colostomy: connects the colon to the abdomen
Urostomy: connects the urinary tract to the abdomen
The stoma may also look different depending on how it was surgically created, as outlined below.
End stoma: An end ostomy is created when the bowel is divided into two separate pieces and the part of the bowel that is coming from the direction of the mouth is brought outside the abdomen. The other end is sewn closed and left inside the abdomen.
Double-barrel stoma: A double-barrel ostomy is similar to an end ostomy but both ends are brought outside of the abdomen. One stoma will drain stool and the other will drain mucous.
Loop stoma: A loop ostomy is made by bringing a loop of bowel through the abdomen wall. A rod or ring is placed under the loop bowel between the skin and the loop. This rod will typically be removed by the child’s medical team within the first month.
RECOMMENDATION:
Connected Care recommends the following considerations when performing stoma assessments on children with ostomies in home and community settings:
A stoma can look different in each child however, the general appearance is usually round or oval, red (like the inside of your mouth), moist and shiny.
There are no nerve endings in the stoma which means the child will not feel pain when it is being touched or when stool is coming out of it.
Stomas may bleed at times when they are cleaned, touched or irritated. To stop bleeding, apply gentle pressure to the stoma with a cloth.
Perform a comprehensive stoma assessment daily and as needed. The table outlined below can be used to guide the stoma assessment.
Contact your local ostomy nurse if you observe the following:
Increase in size of the stoma (prolapse) or shrinking of the stoma below skin level (retraction).
Rash, excoriated skin or other skin issue around the stoma
Consider seeking medical attention in a local emergency department if the child experiences two or more of the following symptoms:
Fever higher than 102°F (38.3°C)
Persistent bleeding from the stoma or blood in the pouch
New redness, swelling, pain, pus or a foul smell from the stoma or incision
Abdominal pain or distention
Vomiting
Diarrhea
No stool output from the stoma for 24 hours
Stoma has changed colour (e.g., black, dark purple, dark blue)
An increase or decrease in amount of stool in the bag over a few hours
Review the AboutKidsHealth Ostomy Learning Hub for more information about ostomy care.
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