Cath Lab Digest

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  For nearly 75 years, colostomy irrigation has been an accepted management option that allows a colostomy patient to control bowel evacuation. Colostomy irrigation evolved as an answer to the nearly universally chronic peristomal skin problems caused by a lack of commercially available pouching systems, protective skin barriers, and skin care products.¹ It was theorized that if the bowel could be evacuated once a day, no stool would seep onto the skin and, therefore, peristomal skin irritation would be minimized. Since that time, however, the procedure has gone in and out of acceptance by both patients and professionals - mostly due to fear of bowel perforation from irrigation catheters. This fear has been reversed by the introduction of soft catheter irrigation cones now available on most colostomy irrigation sets. For many years, nearly all colostomy patients were instructed on colostomy irrigation, but the outcomes were often less than satisfactory for the patient. Today, more realistic criteria have been developed to screen for those patients who have a better chance of success with it.

  Even though colostomy irrigation is not required to maintain bowel function, the procedure is a management option that may allow a patient to be free from fecal discharge for approximately 24 hours. The most important factors to evaluate in determining who is a candidate for colostomy irrigation are the patient's clinical situation and lifestyle. For example, a patient with a sigmoid colostomy who has good manual dexterity and visual acuity, had regular bowel habits prior to surgery, is not undergoing chemotherapy, and is not taking medications that cause diarrhea may appear to be a perfect candidate. However, an assessment of the patient's lifestyle reveals that he works "swing-shift" hours and has an irregular work schedule. It would be nearly impossible for this patient to attempt colostomy irrigation at a regular time each day. Similarly, a physician writes orders for the home care nurse to teach a new patient how to irrigate. The initial home visit reveals that the patient lives in a setting without adequate bathroom facilities and running water. A patient's inability to obtain control over bowel function in the manner prescribed by healthcare professionals can lead to feelings of frustration and failure, which decreases the overall quality of the patient's life.

  A small prospective, crossover study in Singapore² compared natural evacuation (ie, allowing the bowel to function on its own) to colostomy irrigation and found that colostomy irrigation after abdominoperineal resection was superior to natural evacuation in terms of cost and patient satisfaction. When patients irrigated, fewer peristomal skin problems, sleep disturbances, and sexual problems occurred. An overall decrease in management costs also was demonstrated due to a decrease in pouch usage. The study's researchers recommended that colostomy irrigation be introduced to qualified patients soon after surgery.

  In an outcomes-oriented environment, clinicians should evaluate each patient on a case-by-case basis to determine if the patient can benefit from colostomy irrigation. Below are some criteria to consider during this assessment.³ Candidates should have:
    •a descending or sigmoid colostomy
    •a history of regular bowel habits prior to surgery
    •the desire to learn and perform the procedure
    •the ability (manual dexterity and visual acuity) to perform the procedure
    •a lifestyle that is compatible to irrigation (work schedule, bathroom facilities, adequate time, other family or personal issues).