Surgery - stoma care for the neonate
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- Observe colour of the stoma. Observe and document stoma for perfusion, bleeding, skin integrity and signs of infection or prolapse every 4-6 hours.
- Measure stoma output. Notify medical staff if there is >30-49mls/kg/day stoma output.
- Ensure the skin surrounding the stoma is protected from excoriating effects of enzymes by:
- Check stoma with cares 4 to 6 hourly for wound ooze, bleeding (small spots of blood common with cleaning) and bowel motion. Clean with warm sterile saline until wound suture line healed then warm sterile water can be used.
- Post operatively: Measure stoma and cut a hole in the flange of the Hollister Newborn appliance to fit over the stoma, apply then put Newborn pouch onto skin barrier. This should be done immediately post operatively for protection of skin and stoma. The stoma can be viewed through the clear pouch or the pouch can be removed from the flange if the stoma needs to be viewed more closely.
- In the first week post op the stoma will decrease in size as the swelling resolves, therefore the size of the hole cut in the flange will need re-measuring (when new pouch applied).
Stabilising the Stoma
- Stoma pouch must be changed every 3-47 days, or as soon as it leaks.
- Check flange and pouch with cares, ensure flange is not leaking, if the flange is stained underneath then it has leaked and needs to be changed. Pouch needs to be emptied when 1/3 full of bowel motion or gas as it will lift the flange.
- To change pouch if leaking:
- Gather equipment: gloves, bowl, warm water (no soap), gauze, cotton buds, appropriate sized bag and clip, scissors, flange backing for size
- Carefully remove old pouch from the top edge downwards, clean skin with warm water, dry well; assess skin for any signs of excoriation. Assess stoma for any changes in colour, size or excessive bleeding.
- If skin is looking red, use the cavilon no sting barrier film and allow to dry.
- Cut hole in flange to fit the size and shape of stoma, the flange needs to fit over the stoma with a gap of approximately 2mm from edge of stoma to flange. If the flange is too close to the stoma then the mucus from the stoma will cause the flange to lift. If the flange is not close enough to the stoma then the surrounding skin could become excoriated.
- Warm flange between hands for approximately one minute. Apply flange and apply pressure to the flange for one minute and press down all edges. Check the flange is well attached and apply pouch. Close end of pouch with clip provided.
For further information on stomas, contact the Starship Ward 24B Nurse Educator. See also Child Health Intestinal Stoma Care guideline (ADHB only)
Pre-closure of Stoma - Distal End Wash Out
- A contrast study may be requested prior to closure of the stoma, as per individual surgeon orders.
- Ensure that warmed 0.9% sodium chloride 10ml/kg is used.
- With a size 8 feeding tube lubricated with KY jelly, intubate the stoma 1-2cm or until there is resistance.
- Flush saline through with a syringe using minimal pressure.
- Fluid coming out through the rectum must be clear pre operative
Feeding guideline for a baby with a Stoma
Click on the following link to view/download the guideline for advancing enteral feeds in a newborn with a small bowel stoma
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- Date last published: 28 July 2016
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
- Review frequency: 2 years
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