NUR 252 Urostomy

Rockland Community College

Urostomy Items

• 2 pairs of non-sterile gloves, eye protection, waterproof barrier

• Basin of water and 5.5 pH cleanser or warm water (no soap)

• Wick gauzes

• Flange / wafer with leg belt

• Graduated cylinder and scissors

• Mirror (assess for acceptance and body image)

• Urostomy pouch

What is the purpose of a urostomy? Why would someone need one?

• A urostomy is a urinary diversion made with an ileal conduit connected to the ureters. This is brought through the abdominal wall to create a stoma, where urine continuously drains into a urostomy pouch

• This is indicated in patients with bladder cancer, frequent infection, spinal cord injury / trauma

• By removing and re-applying the urostomy device, we can prevent stomal ulceration, necrosis, prolapse, and retraction.

What are adverse effects of a urostomy?

• UTI, kidney infection, sepsis, kidney stones

• Impaired skin integrity, pain and anxiety

• Body image disturbance, sexual dysfunction, reduced quality of life

• Anastomotic leak, stenosis, rupture, and hernia

Urostomy Procedure I

1. Use non-touch aseptic technique throughout the procedure to prevent infection and don clean gloves.

2. Place the patient in semi-fowler’s and put a waterproof pad underneath the pt. Put one towel beneath the stoma and one above.

   • Healthy Stoma: Red, wet with mucus, protrudes above the skin by 0.5–0.75 inches.

   • Unhealthy Stoma: Blue/black/brown (necrosed), bleeding, leaking urine, obstructed, excoriated

   • Stents: Temporarily placed in the ureter to treat kidney stones, tumors, clots, infection. Do not displace stents.

3. Drain the urine into the collection container and COCAF.

4. The urostomy wafer should be changed every 3–7 days. Spray the adhesive remover onto the wafer and peel, or use a silicone-based wipe and peel from the corners. Discard the pouch system. Then, wash hands and don clean gloves.

5. Inspect the stoma and ensure there is good vascularization and no infection at the site. Place the wick over the stoma or stents, then clean around the stoma with 5.5 pH cleanser or clean water.

6. Pat the skin dry with gauze. If there is irritation/excoriation, sprinkle stoma powder on skin and remove excess with dry gauze.

7. During weeks 6-8, the stoma may change size due to inflammation and healing. Measure the stoma with a stoma circle and ensure diameter is < 3mm larger. Trace the circle w/ pen onto the barrier and cut it out. Smooth the edges w/ a gloved finger.

8. Confirm that the barrier fits over the stoma and firmly apply to the skin. Attach urostomy pouch and apply waterproof tape as needed.

9. Assess for redness, irritation, and discomfort. Alert the clinician of stomal or peristomal abnormalities.