Cath Lab Digest

A n ostomy clinic provides patients long-term accessibility to a Certified Ostomy Care Nurse (COCN) or Certified Wound, Ostomy and Continence Nurse (CWOCN) specialist, essential for people requiring ostomies. Preoperative visits for education and stoma site marking, postsurgical visits for follow-up or problem resolution, and guidance and suggestions for patients who have lived with an ostomy for years help promote holistic care. Developing a relationship between the CWOCN/COCN and the patient is of utmost importance, has a positive influence on the patient’s quality of life with the ostomy,¹ and allows individuals to gradually learn the skills necessary to manage the new ostomy, become independent in their care, and adapt successfully to this change in their lives.

Education. Preoperative education regarding the physical care of a newly created ostomy and the psychosocial aspects of daily living offered in an outpatient setting helps allay patients’ fears and anxieties and provides an opportunity for answering their questions. Postoperatively, patients are often overwhelmed by the amount of information they need to learn while recuperating from a major surgical procedure, especially when hospital stays are only 4 or 5 days. Most individuals receive follow-up teaching, direct care, and support from the Visiting Nurse in their community for a limited period of time after discharge. Patients too sick or weak to return directly home are often discharged to a rehabilitation or skilled nursing facility. However, because these support resources are offered short term, follow-up care must be continued in the outpatient setting to facilitate support and education for these patients and provide opportunity for them to establish a long-term relationship with the CWOCN/COCN. Issues regarding resumption of work, school, social and recreational activities; intimacy; and the variety of products available from ostomy companies, as well as issues related to physical care, can be addressed in this environment.

Stoma care. The size and shape of the stoma and abdominal contours change approximately 2 to 6 weeks post surgery, affecting appliance choice. A weight gain or loss of 10 lb or more also may affect the stoma and its topography. Modifications made in the appliance and care offered at timely visits help provide optimal peristomal skin protection to prevent any future complications while ensuring that individuals are using the best products to meet their circumstances. Analysis of data from the Montreux study,¹ where more than 600 enterostomal therapists collected quality-of-life information from more than 4,000 patients in 16 countries in Europe, provides evidence that the first 3 to 6 months after surgery is a critical time period — follow-up with an enterostomal therapist has a positive impact on an individual’s quality of life. This supports the idea that ostomy clinic visits should be an integral part of the comprehensive care provided to anyone who has ostomy surgery.