NURSING CARES IN THE MOST

COMMON COMPLICATIONS OF

DIGESTIVE STOMA

IMMEDIATELY AFTER SURGERY.

Milagros Castro Romera Hospital Universitario de Canarias

WHAT IS A STOMA?

Surgically created opening.

Derivation of the bowel tract

to the outside of the

abdomen.

OSTOMY TYPES

Colostomy

Ascending

Transverse

Descending

Sigmoid

Ileostomy

OSTOMY COMPLICATIONS

Immediate

Oedema

Hemorrhage

Ischemia, necrosis

Infection, sepsis

Stoma retraction

Dehiscence

Evisceration

Late

Stenosis

Hernia

Prolapse

Tumor recurrence

Skin complications

Periestomal dermatitis

Ulcerations

Granulomas

Paraestomal varices

Intestinal fistulas

DEPENDING ON THE AREA

Stoma complications.

Complications of mucocutaneous junction.

Peristomal skin complications

DET SCORE Discolouration

Erosion

Tissue Overgrowth

IMMEDIATE OSTOMY COMPLICATIONS

OEDEMA

Physiological

inflammation of the

intestinal mucosa as

a result of the

manipulation of the

surgical procedure.

OEDEMA. NURSING CARES

HEMORRHAGE

Rare complication (2-3%)

During first hours after operation

Caused by a subcutaneous o submucosal vein

injury.

Late bleeding due to a small wound or

coagulation factors alteration

HEMORRHAGE. NURSING CARES

Evaluate: time of appearance, quantity, origin

and hemodynamic status.

Clear pouch (two-pieces system).

Hygiene

Local hemostasis or manual compression.

Mucosa: silver nitrate, adrenaline

Arterial surface: suture

ISCHEMIA, NECROSIS

Problems of blood supply.

Gradual color change

First 24 h

Establish the affected area.

Conservative or surgical

treatment

ISCHEMIA, NECROSIS. NURSING CARES

Colour

Extent of necrosis

Funcionality

INFECTION, SEPSIS

Asepsis

Symptoms: pain, inflammation, suppuration,

fever

From peristomal inflammation to abcess.

INFECTION, SEPSIS. NURSING CARES

Vigilance Clear pouches

Abcess Drain

Regeneration Hydrocolloid

powders

STOMA RETRACTION

Sinking of the stoma below skin level.

Causes:

Little mobilization

Increased patient weight

Septic complications Peristomal

STOMA RETRACTION. NURSING CARES

DEHISCENCE

Infection and removal of intestinal loop.

Nursing Cares:

Isolate the stoma.

Secondary intention.

Suture.

EVISCERATION

Exteriorization of an intestinal segment through

the abdominal hole.

Isolate the area with wet sterile gauzes until the

surgery.

SKIN COMPLICATIONS

PERIESTOMAL DERMATITIS

Peristomal dermatitis

Stoma

Effluent

Nutrition

General condition

Hygiene

Materials

Caregyver

TYPES OF DERMATITIS

Chemical irritant dermatitis

Mechanical dermatitis

Allergic contact dermatitis

PERIESTOMAL DERMATITIS. NURSING CARES

Characteristics

Cause

Extend and degree

Appropiate pouch

Hygiene

Protective creams, powders

hydrocolloids

Change brand of device

PREVENTION

ULCERATIONS

GRANULOMAS

Small fleshy mass appearing around the stoma

resulting from a persistent skin irritation

caused by sutures not removed in time or

rubbing the mucosa with the edge of the

device.

INTESTINAL FISTULA

Artificial communication between two cavities or between a hollow viscera organ and skin.

Classification: Internal / enteroenteric

External / eenterocutaneus

Diagnosis: Surgery

Methylene blue

Barium enema / GDS

Fistulography

CT

INTESTINAL FISTULA. NURSING CARES

Nutritional control

Pharmacotherapy

Sepsis control

Control drainage

Skin cares

Physical and mental well-being

LATE COMPLICATIONS

STENOSIS

Reduction of light reaching the stoma output

difficult stool.

Partial

Total

Nursing cares:

Diet

Digital expansion

Irrigations

HERNIA

Incisional hernia that

allows protrusion of

abdominal contents

through the abdominal

Cares

Evoid efforts

Flexible pouching systems

Stop irrigation

Surgical treatment

PROLAPSE

Bowel protrudes through the stomal opening in the skin to a greater extent than was anticipated.

Causes:

Oversized hole

Increased abdominal pressure

Excesive exertion

Infants

Obesity

PROLAPSE. NURSING CARES

Control evolution

Cold saline compresses

Avoid fhysical efforts

Manual technique

Surgery