Fear, misunderstanding, loss of self - image and social isolation can compound the situation. Colorectal surgeons and nurses who care for patients with a stoma must recognize that to save someone from a life - threatening condition means little if the life the person returns to is made miserable by a poorly functioning stoma. The objective of any operation involving a stoma is to create a stoma that the patient can care for with simple routine using an appliance that fits reliably, comfortably and protects the surrounding skin.
Time between ostomy changes should be a least once a day, and never longer than seven. There should be no leakage of feces around the appliance. Creation and utilization of a stoma is a team approach involving the patient, the ostomy nurse and the colorectal surgeon.
Patients must assume responsibility for their own health and well - being. They need to learn about their disease and understand what operation is being performed and why. They need to know whether they have a colostomy or ileostomy, and whether it is permanent or temporary. An important thought to keep in mind is "when you do not know, ask".
It is useful to keep a medical summary of one's medical and surgical history written down. So be sure to list current medications, physician's names, addresses and telephone numbers. If a relative or friend has power of attorney or is a health proxy, or if there is a living will, this should also be recorded. One may also choose to obtain copies of operative notes and discharge summaries from recent or complex procedures and hospitalizations. This record is particularly critical when traveling or relocating.
It is important to know that by law a medical facility must make all information about a patient available upon request of the patient. This means that at any time, you can request a copy of your medical record. In particular, patients planning a long journey - usually more than a week - or relocation, should notify their doctor, travel with a copy of their medical record, and prior to leaving, seek and obtain the name and number of a physician at their destination.
The ostomy nurse also plays a critical role in the preoperative and postoperative management. Prior to surgery - in elective or non - emergency casesthe surgeon and nurse sit down to review with the patient what procedure is being done and why. The patient then has his/her body examined while standing, sitting and lying down to determine the best place on the abdominal wall to locate the stoma. One or more sites are then marked so that the surgeon knows where to place the stoma during the procedure. Principles of stoma location and creation include:
While these principles of preoperative assessment and operative management are considered standard of care by colorectal surgeons, there is yet no data that prove the validity of these principles. In addition, some patients with optimally constructed flush stomas function well. For this reason, Cleveland Clinic Florida is conducting the research to determine if the currently espoused methods actually impact upon quality of life and stoma function.
We have developed a "stoma scoring system" and have used this to assess 70 patients in conjunction with validated quality of life estimates as well as appliance wear time and leak rate. Data are currently undergoing statistical analysis and the results will be published. The Cleveland Clinic gratefully acknowledges the participation of UOA and its members and is always pleased to participate in UOA activities. Those seeking care, a second opinion or information from colorectal surgeons in the United States and Canada may contact:
