1924 Dudley Smith – First irrigation system Colostogator/R
Up to now distrust of irrigation technique
Complications – perforation (20 years ago)
Rectale catheter introducted 10 à 30 cm into stoma
Restrictions in sanitary and medical-technical factors
Not well known by stoma patient
Colon irrigation of the stoma
anal irrigation
Tapioca enema
1960 use of cone
Clysma of colon with tepid water
Expansion of colon by overfilling
◦ Introduced 3 tot 4 cm
Reservoir function largest in left colon
◦ Ensures closing, no reflux
Reflective peristaltic contraction
◦ Fits every stoma, 1 size is sufficient
Evacuation of the colon
◦ Dilating effect by exercising pressure
Functions as an anal enema
◦ Less no more perforations!!!
What if the function of the sfincter is insufficient after surgery? ◦ Anal irrigation
as a matter of routine
Only the left colostoma (colon descendens, sigmoïd)
Irrigation of a more highly situated stoma doesn’t make sense ◦ Only during a short time without stool ◦ Disturbs the electrolytes
48h free of stool
◦ Tapioca training ◦ Pelvic training ◦ Choice for definitive stoma?
Occasional colon irrigation
Stoma colon transversum
4h free of stool
Social aspect
Preparation of examination or surgery
When seriously constipated, e.g. food obstruction with ileostoma
Psycho-social Seksual Caring comfort Hygienic advantage Reduction of gas and odour Peristomal skin injuries
◦ Preventive ◦ Curative
No evacuation impulses Wider choice of diet Social-economic aspect Diagnostic parameter
Irrigation as treatment Crohn’s desease, colitis ulcerosa (corticoïds, 5-ASA)
Pre-operative intestinal disinfection
For faecalomen, irrigation with Lysomucil
Don’t add salt, soap, laxatives without prescription!!!
Absolute counterindications Right colostoma Obvious stenosis Persistent diarrhea Crohn’s disease, colitis ulcerosa, familial polyposis in acute stage Acute bleeding Want of time and impatience
Relative counterindications
Peristomal hernia Ileostoma only when obstructed Stomaprolapse Serious cardial stress Serious kidney insufficiency Hypotension Bad short- term prognosis
Good accommodation
Irrigation set
Water-bag with measurement of each 500 ml
Little hook
Supply pipe with pilot clip or roller valve
Cone
lubricant
Drainage bag or sleeve with clips or pegs
Irrigation pump
Biotrol Iryflex/R
Precise and shorter starting speed
Pilot lamp
No increase in intestinal cramps because of speed (1033 cm water pressure)
Indication of temperature
Disadvantage: no refund
15 to 20 ml/kg body- weight Volume dependent on what remains of colon 500 ml would be sufficient Irrigation of loop-stoma: max.500 ml Irrigation of ileostoma when obstructed- 30 ml physiological to inject slowly Irrigation with children - 15 à 30 ml physiological in the distal loop
Patient should never try to solve problems on his own
Ask professional advice
Pt is in condition of stress
Do a digital touch as a matter of routine
Faecalomen
Before the irrigation
Hernia
First irrigation with250 to 500ml
Cone against intestinal wall
Finish first irrigation
Second irrigation with 500ml
Intestinal stenosis
Cleansing of lumen
Direction of entrance is different for each patient
Digital touch (lubricant and little finger)
Distal intestinal trajectory
Change position
Is sometimes question of a few mm
During irrigation: ◦ Close the pilot clip ◦ Not remove cone till cramps stop ◦ Breathe deeply (massage of midriff)
Check flow control
Check on kinks and twists
Check height of water bag
Use of pump
Obstruction
Briden
Stress of pt (certainly when first time)
Irrigation with too cold water
Too high pressure
Hernia
Stricture of the intestine
Tumorous process
Stop the irrigation
Remove drainage bag in good time
Irrigation bag in water level
Irrigate calmly
Rinse between times
Spasms of stoma
Eliminate odour (e.g.Ecoclinic®)
Use of lubricant
Active process of disease
matchsticks Potpourri or aromatic stick Ground coffee on radiator
Leakage during irrigation
Drinking of cold water
Nausea and syncope
High-fibre diet
Diarrhea in spite of irrigation
Drink water sufficiently
Perineal pain
NO laxatives
Tension
Extreme fatigue – obstruction transit
Deshydratation
Change position
Massage abdomen
Increase irrigation
Fecal incontinence
Disorders of the nervous system (difficult evacuation)
Damaged spinal marrow
Chronic constipation
Cf.colon irrigation stoma
Regular
To begin with on daily basis
Tepid water (37 tot 38°C)
750 to 1000ml
Sitting on toilet
Evacuation time 30 to 45’
Colonirrigatie de brug naar continente stomazorg/ Frans Meuleneire - Kluwer editoriaal British Journal of Nursing 2006, Vol 15, n°16, p.854-8 62 Productinfo: www.coloplast.be
◦ Cone ◦ Water bag ◦ Tepid water at body temperature
Freedom of movement is increased from 24 to 48h
Less harmful than laxation
Simple to learn at any age
Less loss of stool between times
Fill the large syringe with cooled down tapioca
Apply lubricant to cone
Connect syringe with cone
Introduce tapioca
Pt holds up the introduces matter as long as possible
