Part of the ICU Emergencies Hub — browse every related guide in one place.
| Type | Source | Output Character | Key Nursing Concerns |
|---|---|---|---|
| Colostomy | Colon (sigmoid, descending, transverse) | Formed to semi-formed stool; less frequent output; odor present | Bowel regulation; skin protection; diet education |
| Ileostomy | Ileum (small bowel) | Liquid to pasty; continuous high-volume output; highly caustic to skin (contains digestive enzymes) | High-output dehydration risk; peristomal skin breakdown from enzyme contact; electrolyte losses |
| Urostomy (ileal conduit) | Ureters diverted through ileal segment to abdominal wall | Urine; continuous flow; mucus strands are normal (from ileal segment) | UTI prevention; urinary drainage; skin protection from urine |
| Characteristic | Normal | Abnormal — Notify Provider |
|---|---|---|
| Color | Beefy red to deep pink; moist and shiny | Pale (poor perfusion); dusky purple/black (ischemia — surgical emergency) |
| Size | Edematous immediately post-op; shrinks over 6–8 weeks to permanent size | Significant sudden change in size; retraction below skin level |
| Shape | Round or oval; slightly raised above skin (budded) | Flush or retracted below skin level (causes leakage and peristomal breakdown) |
| Peristomal skin | Intact, same appearance as surrounding skin | Erythema, erosion, satellite lesions (candida), hyperplasia from chronic moisture exposure |
| Output | Colostomy: formed stool; Ileostomy: liquid (initially), thickens slightly; Urostomy: clear yellow urine | No output for more than 4–6 hours (obstruction); output greater than 1,000–1,500 mL/day in ileostomy (high output — dehydration/electrolyte risk) |
The goals of pouching are to collect output without leakage, protect peristomal skin from contact with output, and remain odor-contained. Systems are either one-piece (skin barrier and pouch in a single unit) or two-piece (separate wafer/barrier that adheres to skin, with a detachable pouch that snaps on).
Step-by-step application: Empty and remove the old pouch (if changing). Clean the peristomal skin with warm water — no soap with lotions or oils (prevents barrier adhesion). Pat dry completely. Measure the stoma with a measuring guide (stoma size changes for 6–8 weeks post-op; measure at each change). Cut the skin barrier opening to fit 1/8-inch larger than the stoma diameter (allows stoma to swell without constriction, but minimizes exposed skin). Apply skin barrier paste or ring around the opening if needed for irregular skin surfaces. Warm the wafer briefly in hands (body temperature improves adhesion). Apply wafer centered over the stoma; hold with gentle pressure for 30–60 seconds. Snap or fold the pouch closed.
Ileostomy output greater than 1,000–1,500 mL per day is defined as high-output and requires active management. High output causes dehydration, hyponatremia, hypokalemia, and hypomagnesemia — the small bowel normally absorbs electrolytes and water that the lost ileal output now bypasses. Signs: excessive thirst, concentrated urine, decreased urine output, muscle cramps (electrolyte depletion), fatigue, tachycardia.
Nursing management: accurate I&O tracking; daily weights; monitor electrolytes; IV fluid and electrolyte replacement per order; dietary counseling (avoid high-fiber, high-sugar foods that increase output; encourage sodium-containing foods and oral rehydration solutions rather than plain water); loperamide (Imodium) may be ordered to slow motility and reduce output. Consult wound, ostomy, and continence (WOC) nurse specialist for high-output management and pouching challenges.
Before discharge, the patient must demonstrate competency in: emptying the pouch (done when 1/3 to 1/2 full), removing and applying the pouching system independently, measuring the stoma and cutting the barrier, identifying signs of complications (stomal color changes, persistent leakage, skin breakdown, no output), and dietary modifications specific to their ostomy type.
Empty the pouch while sitting on the toilet or standing over it — pouch tail directed into the bowl. Drainable pouches should be emptied 3–6 times daily (or when 1/3 full); closed-end pouches (for formed colostomy output) are discarded after each use. Pouching systems are typically changed every 3–5 days (not daily — frequent changes damage peristomal skin).
Related guides: Wound care | Fluid and electrolytes | Discharge teaching
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