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Ostomy Care (Pediatric) (2.18P)

Ostomy Care (Pediatric) (2.18P) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Gastrointestinal

2.18P

NURSING PATIENT CARE POLICY & PROCEDURE




Effective Date:
September 22, 2017
Administrative Manual
Nursing Manual (Red)
Other _______________
Policy #: 2.18P
Original
Revision
Page
1
of 4
Title: Ostomy Care (Pediatric)

I. PURPOSE

To provide guidance for ostomy care in the pediatric setting.

II. DEFINITIONS

A. Infants: Birth to 12 months
B. Toddlers: 12 months to 3 years old
C. Pre School: 3 years to 5 years old
D. School Age: 5 years to 12 years old
E. Teenager/Adolescent: 12 years to early 20s
F. One Piece Pouch System: Pouch attached to wafer/barrier
G. Two Piece Pouch System: Wafer/barrier and pouch

III. POLICY

A. The nurse caring for the pediatric patient is responsible for routine ostomy care
and teaching.
B. Routine ostomy care is performed every two to three (2-3) days and more often if
necessary, while the patient is hospitalized.
C. The Wound, Ostomy, Continence (WOC) Clinical Nurse Specialists, Certified
Wound Ostomy Care Nurses and AFCH General Surgery Nurse Practitioners
function as consultants to assist with product selection, application,
complications, patient education and discharge.

IV. EQUIPMENT

A. Pouch System:
1. One Piece Cut to Fit (Infants)
2. Two Piece Cut to Fit (Infants)
3. Adhesive Coupling (Toddlers)
4. Two Piece Moldable (Pre School, School Age, Teenager/Adolescent)
5. One piece cut-to-fit (Pre School, School Age, Teenager/Adolescent)
B. Measuring guide or stoma pattern
C. Non-sterile exam gloves
D. 2x2 or 4x4 gauze pads
E. Optional:
1. Alcohol Free Sting Free Adhesive Remover Wipe (For infants, toddlers
and preschoolers use only if necessary. SHIELD INFANT’S FACE IF
USING THE ADHESIVE REMOVER SPRAY.)

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2. Alcohol Free Sting Free Skin Protectant Wipe (For infants, toddlers and
preschoolers use only if necessary.)

V. PROCEDURE

A. Prepare patient by explaining the procedure (to patient, parents or primary care
giver).
B. During the procedure, explain each step to the patient, parents or primary
caregiver. It is the expectation that patients, parents, or the primary caregiver
observe and or participate in ostomy care/appliance change
C. Assemble supplies.
D. Position patient.
E. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand
Hygiene.
F. Choose and prepare appropriate pouch system:
1. Refer to the “Ostomy Product Selection Guide” document on the
Wound, Skin, Ostomy and Continence website (U-Connect) for
appropriate type wafer/barrier and pouch.
2. Wear non-sterile exam gloves and use stoma guide to measure stoma for
appropriate size of pouch system.
a. Moldable: Refer to measuring color guide for size.
b. Cut to Fit: Use the size of the hole in the measuring guide to
determine size of the pouch system.
c. If using two piece pouch system, mold wafer/barrier starter hole
to stoma size and shape.
d. If using one piece pouch system, trace and cut starter hole to
stoma size and shape.
G. Empty pouch prior to removal.
H. With non-sterile exam gloves on, remove existing pouch and wafer/barrier:
1. Infants, Toddlers, Pre-School: Use 2x2 or 4x4 gauze pad soaked in
lukewarm water. May use alcohol free adhesive remover if necessary.
2. School Age, Teenager/Adolescent: Use alcohol free sting free adhesive
remover.
I. Use gauze pad to collect waste while appliance is off.
J. Cleanse peristomal skin and stoma gently with gauze soaked in lukewarm water.
K. Dry skin thoroughly.
L. Assess stoma and surrounding skin. Consult Certified Wound Ostomy Care Nurse
for noted complications.
M. Protect skin around stoma.
1. Infants, Toddlers, Pre School: Only if necessary, apply alcohol free skin
protectant on skin around stoma and allow to dry.
2. School Age, Teenage, Adolescent: Apply alcohol free skin protectant on
skin around stoma and allow to dry.
N. Remove clear round plastic backing from wafer/barrier. Leave outer release paper
on the tape collar in place. Use tape collar to hold onto when applying
wafer/barrier to abdomen.
O. Apply wafer/barrier (skip to P if using one piece pouching system).
1. If using Two Piece Pouch System:
a. Apply wafer/barrier or baseplate (Adhesive Coupling)

Page 3 of 4

b. Adhesive Coupling (AC): Center the baseplate around the stoma.
Press the baseplate slowly and carefully on to the skin, starting at
the stoma and moving to the outer rim.
c. Wafer/Barrier Moldable: Apply wafer/barrier (moldable with
accordion flange) to abdomen. Press and maintain with gentle
pressure for 30 seconds. Immediately press and gently rub the
wafer with a finger around the stoma to ensure adhesion.
P. Attach pouch.
1. Position pouch.
a. Non-ambulatory: To patient’s side.
b. Ambulatory: Towards patient’s leg.
i. Adhesive Coupling (AC)
• Gently press the pouch to the entire baseplate by
adhering the adhesive ring around the stoma,
avoiding crease and wrinkles. Press lightly on the
pouch and baseplate to ensure complete adhesion.
ii. Wafer/Barrier Moldable
• Attach to accordion flange. You will hear a series
of audible “clicks” as the system locks into place.
iii. One Piece Pouch System
• Gently place the pouch system over the stoma.
Press the skin barrier against the skin, with the
bottom hole edge closest to the bottom stoma
edge.
• Secure tail end pouch closure with built in Velcro
integrated closure system or with a tail bag clamp
if using a non-Velcro closure system.
Q. Dispose of used pouch and gloves in trash can. Biohazard trash can is not
necessary.
R. Remove gloves and perform hand hygiene.
S. Document in the patient’s clinical record in the daily LDA, I/O and Patient
Education.

VI. UW HEALTH CROSS REFERENCES

A. Health Facts For You (HFFY) 7652, Caring For Your Child’s Ostomy
B. UW Health Clinical Policy 4.1.8, Standard Precaution and Isolation
C. UW Health Clinical Policy 4.1.13, Hand Hygiene
D. Ostomy Product Selection Guide (found on the Wound, Skin, Ostomy and
Continence website on U-Connect)

VII. REFERENCES

A. Erwin-Toth, P., & Doughty, D. (2010). Principles and procedures of stomal
Management. Ostomies and continent diversions: nursing management. St. Louis,
MO: Mosby.
B. Wound, Ostomy and Continence Nurses Society (2010). Management of the
patient with a fecal ostomy: best practice guideline for clinicians. Mount Laurel,
NJ: Wound, Ostomy, and Continence Nurses society (WOCN).

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C. Wound, Ostomy and Continence Nurses Society (2011). Pediatric Ostomy Care:
Best Practice for Clinicians. Mount Laurel, NJ: Wound, Ostomy and Continence
Nurses Society (WOCN).

VIII. WRITTEN BY

Certified Wound Ostomy Nurses
AFCH General Surgery Nurse Practitioners

IX. REVIEWED BY

AFCH General Surgery Nurse Practitioners
Clinical Nurse Specialists, Wound & Skin (CWOCN)
Clinical Nurse Specialist, Universal Care Unit and Float Team
Nursing Patient Care Policy and Procedure Committee, September 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive