Urinary and Bowel Elimination

Transcription

1 Chapter 8 Urinary and Bowel Elimination Procedure 47 Testing Urine With Reagent Strips Procedure 48 Measuring Urine Specific Gravity With A Urinometer Procedure 49 Inserting A Straight Catheter Procedure 50 Inserting An Indwelling Catheter Procedure 51 Open Bladder Irrigation Procedure 52 Closed Bladder Irrigation Procedure 53 Continuous Bladder Irrigation Procedure 54 Removing An Indwelling Catheter Procedure 55 Breaking Up And Removing A Fecal Impaction Procedure 56 Changing An Ostomy Appliance Procedure 57 Irrigating A Colostomy

2 Procedure 47 Testing Urine With Reagent Strips PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Specimen collection container Bottle of reagent strips Plastic bag for used supplies, if needed Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure Read the directions on the bottle for the strip you are using. 2. Dip the end of the strip impregnated with reagent into the urine specimen. Hold the strip in the sample for the designated length of time and then remove. 3. Wait for the length of time specified in the directions. 4. Hold the strip next to the color chart on the package. Compare the color. Record the reading, which is listed below each color on the chart. 5. Discard the strip and urine specimen according to facility policy. 6. Record the patient s intake and output, if applicable.

3 Procedure Guidelines S/U Initials S/U Initials 7. Perform your procedure completion Instructor Signature Student Signature

4 Procedure 48 PERFORMANCE REVIEW CHECKLIST Measuring Urine Specific Gravity With A Urinometer Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Calibrated urinometer and cylinder Container for urine specimen Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Carefully pour urine into the cylinder until it is 3 4 full. 3. Gently spin the urinometer, then drop it into the cylinder. If the device hits the side of the container and stops spinning, repeat this step. 4. Wait for the urinometer to stop bobbing, then read the value on the stem, or meniscus. Wait until the device stops moving, and make sure it does not touch the sides of the container, which will cause an inaccurate reading. 5. Position yourself so the meniscus is close to eye level. You should be able to clearly see the numbers and position of the meniscus. Take the reading on the lowest point of the scale.

5 6. Discard the urine. Procedure Guidelines S/U Initials S/U Initials 7. Rinse the container with cool water. Avoid using warm water, which may cause proteins in the urine to adhere to the container. 8. Perform your procedure completion Instructor Signature Student Signature

6 Procedure 49 Inserting A Straight Catheter PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Bath blanket Washcloth Towel Underpad or incontinent pad Washbasin of warm water Soap Plastic bag for used supplies Catheterization tray Catheter size as directed by the RN Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Place the underpad under the patient s buttocks. 3. Position and drape the patient for perineal care. 4. Apply gloves. 5. Provide perineal care. 6. Discard used supplies. 7. Wash your hands.

7 Procedure Guidelines S/U Initials S/U Initials 8. Adjust or position the lighting, if necessary. 9. Clean the overbed table. Disinfect the table, if soiled, or if required by facility policy. 10. Open the catheterization tray and establish a sterile field. 11. Open the catheter and place it on the sterile field. 12. Place the plastic bag for used supplies at the foot of the bed, or in a convenient location. Position the bag so that you do not have to cross over sterile supplies to discard soiled items. 13. Apply sterile gloves. 14. Open the sterile packages on the sterile field, and arrange supplies as needed. 15. Inspect the catheter for cracks or rough spots. If found, replace the catheter. 16. Open the package of povidone-iodine or other antiseptic solution. Carefully pour the solution over the cotton balls or applicators. 17. Open the package of lubricant. 18. Lubricate the tip of the catheter. The lubricant should cover the catheter for approximately 2 inches for a female and 4 to 5 inches for a male. 19. Pick up the first drape. Stand away from the bed and hold the drape away from your body, allowing it to unfold. 20. Fold the drape back, over your gloves. Ask the patient to lift his or her buttocks. Carefully slide the drape under the buttocks. Avoid touching the patient or the bed linen. 21. Pick up the next drape. Stand away from the bed and hold the drape away from your body, allowing it to unfold.

8 Procedure Guidelines S/U Initials S/U Initials 22. Position the hole in the center of the drape over the perineum. If it is necessary to lift the penis to position the drape, use your nondominant hand. This hand will be contaminated after touching the patient s skin and cannot be used to contact sterile supplies. 23. With the forceps in the tray, pick up a cotton ball moistened with disinfectant solution. Cleanse the genitals: Female patient: Separate the labia with the nondominant hand. This hand is now contaminated. Wipe the labia from top to bottom, on the side opposite where you are standing, with the cotton ball. Use one stroke, then discard the cotton ball. Next, pick up another cotton ball and repeat the procedure on the labia closest to you. Discard the cotton ball. Pick up one more cotton ball, and cleanse the center of the labia from top to bottom. Discard the cotton ball and forceps. Keep the labia separated throughout the procedure. Do not let go after cleansing. Male patient: Pick up the penis with the nondominant hand. This hand is now contaminated. Retract the foreskin of the penis. Beginning at the urinary meatus, wipe the penis in a circular motion. Discard the cotton ball. Next, pick up another cotton ball and repeat the procedure, cleansing outward from the meatus in a circle. Discard the cotton ball. Pick up one more cotton ball, and cleanse in a circle beyond the second circle. When done, you should have cleansed a large area. Discard the cotton ball and forceps. 24. Place the open end of the catheter into the specimen collection container or drainage basin positioned in front of the labia. 25. Pick up the catheter. Hold it approximately 11 2 to 2 inches from the tip.

9 Procedure Guidelines S/U Initials S/U Initials 26. Insert the catheter into the urethra. Female patient: Visualize the urinary meatus Tell the patient you will be inserting the catheter now. Instruct the patient to cough, take a deep breath, or whistle. This will help relax the urinary sphincter. Insert the catheter into the urethra, threading it into the bladder (about 21 2 or 3 inches) until urine flows. If urine does not flow immediately, hold the catheter in place until urine drains. If no urine flows, the catheter may be in the vagina. Leave it in place. You must get fresh supplies and repeat the procedure. Leaving it in place will make it easier to find the urethra the next time. Remove it after the catheterization is successful. If an assistant is helping you, continue to hold the labia apart, and send him or her for another catheter. When he or she returns, have the assistant open the catheter. Grasp it with your sterile hand, and repeat the procedure. Male patient: Hold the penis upright with your nondominant hand. Insert the catheter into the meatus. Tell the patient you will be inserting the catheter now. Instruct the patient to cough, take a deep breath, or whistle while you are inserting the catheter. The patient may also bear down, as if to urinate. Encourage him to continue throughout the procedure. Advance the catheter until urine flows. Never force a catheter. If you meet resistance and are unable to advance the catheter, stop the procedure and notify the RN.

10 Procedure Guidelines S/U Initials S/U Initials 27. Collect a specimen, if ordered. Collect approximately 30 to 50 ml of urine in the specimen cup, then pinch the catheter to stop the flow of urine. Move the cup to the side and position the drainage basin under the end of the catheter. Allow the bladder to empty into the basin. If 1,000 ml of urine drains from the bladder and urine continues to flow, pinch the catheter and contact the RN. Some facilities require you to empty an overfull bladder over a period of time to prevent complications. Some facilities allow the bladder to empty completely. (This is a controversial area requiring further research.) 28. Slowly withdraw the catheter. 29. Replace the foreskin in the male patient. 30. Remove the drapes. Discard in the plastic bag. 31. Perform your procedure completion Instructor Signature Student Signature

11 Procedure 50 Inserting An Indwelling Catheter PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Bath blanket Washcloth Towel Underpad or incontinent pad Washbasin of warm water Soap Plastic bag for used supplies Catheterization tray Catheter size as directed by the RN Sterile collection bag, if not listed in contents on catheterization tray Tape or Velcro strap to secure the catheter Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Place the underpad under the patient s buttocks. 3. Position and drape the patient for perineal care. 4. Apply gloves. 5. Provide perineal care. 6. Discard used supplies.

12 7. Wash your hands. Procedure Guidelines S/U Initials S/U Initials 8. Adjust or position the lighting, if necessary. 9. Clean the overbed table. Disinfect the table, if soiled, or if required by facility policy. 10. Open the catheterization tray and establish a sterile field. 11. Open the catheter and place it on the sterile field. 12. Place the plastic bag for used supplies at the foot of the bed, or in a convenient location. Position the bag so that you do not have to cross over sterile supplies to discard soiled items. 13. Apply sterile gloves. 14. Open the sterile packages on the sterile field, and arrange supplies as needed. Attach the indwelling catheter to the drainage bag if no specimen will be collected. Check the clamp over the drainage spout to ensure that it is closed. 15. Inspect the catheter for cracks or rough spots. If found, replace the catheter. 16. Attach the saline-filled syringe to the inflation port on the catheter. Inject the fluid into the catheter to check the balloon for leaks. If the balloon will not inflate, or if leaks are present, replace the catheter. Pull back on the plunger of the syringe to deflate the balloon. 17. Open the package of povidone-iodine or other antiseptic solution. Carefully pour the solution over the cotton balls or applicators. 18. Open the package of lubricant. 19. Lubricate the tip of the catheter. The lubricant should cover the catheter for approximately 2 inches for a female and 4 to 5 inches for a male. 20. Pick up the first drape. Stand away from the bed and hold the drape away from your body, allowing it to unfold.

13 Procedure Guidelines S/U Initials S/U Initials 21. Fold the drape back, over your gloves. Ask the patient to lift his or her buttocks. Carefully slide the drape under the buttocks. Avoid touching the patient or the bed linen. 22. Pick up the next drape. Stand away from the bed and hold the drape away from your body, allowing it to unfold. 23. Position the hole in the center of the drape over the perineum. If it is necessary to lift the penis to position the drape, use your nondominant hand. This hand will be contaminated after touching the patient s skin and cannot be used to contact sterile supplies. 24. With the forceps in the tray, pick up a cotton ball moistened with disinfectant solution. Cleanse the patient: Female patient: Separate the labia with the nondominant hand. This hand is now contaminated. Wipe the labia from top to bottom, on the side opposite where you are standing, with the cotton ball. Use one stroke, then discard the cotton ball. Next, pick up another cotton ball and repeat the procedure on the labia closest to you. Discard the cotton ball. Pick up one more cotton ball, and cleanse the center of the labia from top to bottom. Discard the cotton ball and forceps. Keep the labia separated throughout the procedure. Do not let go after cleansing. Male patient: Pick up the penis with the nondominant hand. This hand is now contaminated. Retract the foreskin of the penis. Beginning at the urinary meatus, wipe the penis in a circular motion. Discard the cotton ball. Next, pick up another cotton ball and repeat the procedure, cleansing outward from the meatus in a circle. Discard the cotton ball. Pick up one more cotton ball, and cleanse in a circle beyond the second circle. When done, you should have cleansed a large area. Discard the cotton ball and forceps.

14 Procedure Guidelines S/U Initials S/U Initials 25. If a specimen will be collected, place the open end of the catheter into the specimen collection container or drainage basin positioned in front of the patient. 26. Pick up the catheter. Hold it approximately 11 2 to 2 inches from the tip. 27. Insert the catheter into the urethra. Female patient: Visualize the urinary meatus. Tell the patient you will be inserting the catheter now. Instruct the patient to cough, bear down, or whistle. This will help relax the urinary sphincter. Insert the catheter into the urethra, threading it into the bladder (about 21 2 or 3 inches) until urine flows. If urine does not flow immediately, hold the catheter in place until urine drains. If no urine flows, the catheter may be in the vagina. Leave it in place. You must get fresh supplies and repeat the procedure. Leaving it in place will make it easier to find the urethra the next time. Remove it after the catheterization is successful. If an assistant is helping you, continue to hold the labia apart, and send him or her for another catheter. When he or she returns, have the assistant open the catheter. Grasp it with your sterile hand, and repeat the procedure. Male patient: Hold the penis upright with your nondominant hand. Insert the catheter into the meatus. Tell the patient you will be inserting the catheter now. Instruct the patient to cough, bear down, or whistle while you are inserting the catheter. Encourage him to continue throughout the procedure. Advance the catheter until urine flows. Never force a catheter. If you meet resistance and are unable to advance the catheter, stop the procedure and notify the RN.

15 Procedure Guidelines S/U Initials S/U Initials 28. Collect a specimen, if ordered. Collect approximately 30 to 50 ml of urine in the specimen cup, then pinch the catheter to stop the flow of urine. Move the cup to the side and position the drainage basin under the end of the catheter. Allow the bladder to empty into the basin. If 1,000 ml of urine drains from the bladder and urine continues to flow, pinch the catheter and contact the RN. Some facilities require you to empty an overfull bladder over a period of time to prevent complications. Some facilities allow the bladder to empty completely. (This is a controversial area requiring further research.) 29. Pick up the syringe and attach it to the inflation port in the catheter. Slowly push the plunger to inflate the balloon. 30. Attach the collection bag to the catheter, if this was not done previously. 31. Hang the collection bag on the bed frame. Do not let it touch the floor. 32. Replace the foreskin in the male patient. 33. Tape the catheter or apply a Velcro leg strap to secure the catheter. Do not leave the room until the catheter is secured. The mechanical irritation caused by catheter movement can cause complications. The catheter in the female is secured to the upper thigh. The catheter in the male is secured to either the upper thigh or the abdomen. 34. Remove the drapes. Tear the center of the fenestrated drape to remove it over the catheter. Discard in the plastic bag. 35. Perform your procedure completion Instructor Signature Student Signature

16 Procedure 51 Open Bladder Irrigation PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Sterile gloves Sterile irrigation set Sterile irrigation solution, as ordered by the physician Sterile basin (may be part of the irrigation set) Sterile protective cap for drainage tube Alcohol or povidone-iodine wipes Underpad Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Place the underpad under the connection between the catheter and the drainage tube. 3. Open the sterile irrigation set. Remove the lid of the container. Set it on the table with the inside facing up. 4. Open the irrigation solution and pour it into the irrigation set. The irrigation syringe is sterile. Avoid contaminating it during this part of the procedure.

17 5. Close the irrigation set. If the syringe was removed, return it to the solution. 6. Apply exam gloves. 7. Place the basin on the bed, under the connection between the catheter and the drainage tube. 8. Disconnect the catheter from the drainage tube. (Wipe the connection site first with alcohol or povidone-iodine, if this is your facility policy.) Apply a sterile protective cap to the connection on the drainage tube. 9. Position the tubing on the bed so it does not fall on the floor. 10. Place the end of the catheter in the sterile basin. 11. Remove gloves and discard according to facility policy. 12. Wash your hands. 13. Open package and apply sterile gloves. 14. Withdraw the specified amount of irrigation solution into the syringe. 15. Instill the correct amount of solution into the catheter. 16. Pinch the catheter closed, then remove the syringe. Take care not to contaminate the tip. Insert the syringe into the irrigation solution container. 17. Hold the end of the catheter over the sterile basin and allow the fluid to drain into the basin. Note the color, character, consistency, and amount of drainage. 18. Withdraw additional fluid, and repeat the procedure until the irrigation fluid returns clear and no blood clots are present. 19. Remove the cover from the connection on the drainage tube. Wipe the connection with alcohol or povidoneiodine, if this is your facility policy. 20. Securely connect the catheter to the drainage tubing. 21. Empty the basin. Procedure Guidelines S/U Initials S/U Initials

18 Procedure Guidelines S/U Initials S/U Initials 22. Remove gloves and discard according to facility policy. 23. Secure the catheter to the patient s thigh with tape or a Velcro band, or tape the male patient s catheter to the abdomen. 24. Perform your procedure completion Instructor Signature Student Signature

19 Procedure 52 Closed Bladder Irrigation PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Sterile irrigation set Sterile irrigation solution, as ordered by the physician Sterile 30-mL syringe Sterile 21-gauge needle Catheter clamp Alcohol or povidone-iodine wipes Underpad Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Place the underpad under the connection between the catheter and the drainage tube. 3. Open the sterile irrigation set. Remove the lid of the container. Set it on the table with the inside facing up. 4. Open the irrigation solution and pour it into the irrigation set. Avoid contaminating the irrigation syringe during this part of the procedure.

20 5. Draw up the amount of irrigation solution ordered, using the 30-mL syringe. 6. Open the needle and place it on the syringe. 7. Apply gloves. Procedure Guidelines S/U Initials S/U Initials 8. Clamp the catheter, distal to the injection port. 9. Cleanse the injection port with alcohol or povidone-iodine. Allow to dry. 10. Insert the needle into the injection port. Slowly inject the solution into the port. 11. Withdraw the syringe from the port. 12. Remove the clamp. 13. Repeat the irrigation as ordered, or until the solution is clear with no blood clots. Clamp the catheter again each time you inject solution. 14. Remove gloves and discard according to facility policy. 15. Perform your procedure completion Instructor Signature Student Signature

21 Procedure 53 Continuous Bladder Irrigation PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Sterile irrigation solution, as ordered by the physician Sterile administration set for irrigation solution IV standard Alcohol or povidone-iodine wipes Underpad Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Open the package for the administration set. Remove the cover from the spike. Avoid touching the spike, which is sterile. Insert the spike into the container of irrigation solution. 3. Hang the irrigation solution on the IV pole, 20 to 30 inches above the patient. 4. Fill the drip chamber halfway. Prime the tubing as you would for an IV. 5. Apply gloves.

22 6. Using aseptic technique, remove the cover from the tubing. Attach it to the irrigation port in the three-way catheter. 7. Discard used supplies. 8. Remove gloves and discard them according to facility policy. 9. Wash your hands. Procedure Guidelines S/U Initials S/U Initials 10. Adjust the drip rate of the irrigation solution, using the roller clamp. 11. Repeat the irrigation procedure, changing bags as ordered. Use aseptic technique to avoid contamination. 12. Perform your procedure completion Instructor Signature Student Signature

23 Procedure 54 Removing An Indwelling Catheter PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves, 2 pair 10-mL syringe Underpad Plastic bag for used supplies Washcloth Towel Washbasin Soap Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Position the underpad under the patient s buttocks. 3. Remove the tape or Velcro strap securing the catheter to the leg. 4. Manipulate the tubing so that any urine in the tubing flows into the drainage bag. 5. Open the syringe. Attach the syringe to the inflation port.

24 6. Withdraw the fluid from the balloon. The amount of fluid in the balloon may be marked on the catheter. Make sure you withdraw this amount. Depending on the catheter used, the port may flatten when the fluid is withdrawn. Empty the fluid from the syringe, reinsert the needle, and attempt to withdraw fluid again. When you are satisfied that the balloon is empty, proceed to the next step. 7. Gently pull the catheter. If you meet resistance, stop. The balloon may not be completely deflated. Repeat steps 5 and If no resistance is met, withdraw the catheter. Observe the tip for the presence of sediment, blood, or mucus. If present, inform the RN. He or she may request a culture. 9. Disconnect the catheter from the drainage tubing. Discard the catheter in the plastic bag, or according to facility policy. Some facilities culture the tip of the catheter after it is removed. If this will be done, you will need a sterile specimen cup and sterile scissors. After removing the catheter, hold the end over the open specimen cup and clip it 3 inches from the tip. Cover the cup and discard the remainder of the catheter. 10. Remove gloves and discard in the plastic bag. 11. Wash your hands. Procedure Guidelines S/U Initials S/U Initials 12. Apply clean gloves. 13. Perform perineal care according to facility policy. 14. Empty the catheter bag and measure output. Discard the empty bag in the plastic bag, or according to facility policy. 15. Perform your procedure completion

25 Instructor Signature Student Signature

26 Procedure 55 PERFORMANCE REVIEW CHECKLIST Breaking Up And Removing A Fecal Impaction Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves Water-soluble lubricant Bedpan Underpad Toilet tissue Plastic bag for used supplies Washcloth Towel Washbasin Soap Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Position the underpad under the patient s buttocks. 3. Position the patient in the Sims position. The patient should be on the left side, with the upper leg bent at the knee and positioned forward, over the lower leg. 4. Apply disposable gloves.

27 5. Position the bedpan, toilet paper, and plastic bag at the end of the bed, or in another convenient location where you can reach them. 6. Apply lubricant to your index finger. 7. Gently insert your index finger into the rectum. Instruct the patient to take slow, deep breaths. After the anus relaxes, two lubricated fingers can be inserted, if necessary. 8. Move your finger upward, probing for a hard fecal mass. If present, move your finger from side to side in the mass to break it up. 9. Continue to manipulate the stool, breaking it up into small pieces. 10. After the stool is broken into smaller pieces, bend your finger forward slightly and hook a piece of stool, pulling it downward and removing it from the rectum. Discard it in the bedpan. 11. Repeat the hooking action until all stool is removed. 12. Wipe the anus with toilet paper. Discard used paper in the bedpan. 13. Remove your gloves and discard them in the plastic bag. 14. Wash your hands. Procedure Guidelines S/U Initials S/U Initials 15. Fill the washbasin with warm water and carry it to the bedside. 16. Apply clean gloves. 17. Wash the patient s rectum, or provide perineal care, according to facility policy. 18. Discard the contents of the bedpan in the toilet, or according to facility policy. 19. Perform your procedure completion Instructor Signature Student Signature

28 Procedure 56 Changing An Ostomy Appliance PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves, 2 pair Bedpan Clean, drainable ostomy pouch Skin barrier product Gauze pads or disposable washcloths Washbasin of warm water Hand towel Toilet tissue Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Position the bedpan next to the patient, on the side with the stoma. 3. Position the end of the appliance in the bedpan. Remove the clip at the bottom and empty the device into the bedpan. 4. Gently lift the appliance to release the adhesive. Apply traction on the skin with one hand while slowly and gently lifting the pouch with the other.

29 Procedure Guidelines S/U Initials S/U Initials 5. Discard the pouch, or put it to the side for cleaning and reuse, according to the type of device. 6. Gently wash the skin surrounding the stoma with warm water. Pat dry with the hand towel. If stool escapes during this procedure, remove it with toilet tissue. Monitor the skin for changes in the size, color, or presence of redness or skin breakdown. Report these changes to the RN. 7. Apply skin barrier product. 8. Change your gloves, if soiled with stool. 9. Check the opening in the new pouch to ensure that it is large enough to fit the stoma. It should not fit tightly to the edges. 10. Remove the paper backing from the adhesive seal, or apply the skin barrier product, or moisten the ring, depending on the type of appliance used. 11. Center the ring in the pouch over the stoma, with the large part of the pouch down. Gently press it down over the skin. Make sure the adhesive is wrinklefree. Hold gentle pressure on the adhesive ring for a minute. 12. Check the end of the pouch to ensure that it is closed and clamped securely. 13. Perform your procedure completion Instructor Signature Student Signature

30 Procedure 57 Irrigating A Colostomy PERFORMANCE REVIEW CHECKLIST Name of Patient Care Technician of Program to Social Security Number or Identification Number _ Program Code Number (if any) S=Satisfactory Performance U=Unsatisfactory Performance Place a full signature to correspond with each set of initials appearing below. Initials Corresponding Signature of Instructor Title Supplies needed: Disposable exam gloves, 2 pair IV standard (or hook on bathroom door) Irrigation bag with 1,000 ml warm water (about 100 F) Gauze sponges or disposable washcloths to clean skin Mild soap Hand towel Washbasin, if the procedure is performed in bed Water-soluble lubricant Irrigation sleeve with belt or self-adhesive ring Bedpan, if the procedure is performed in bed 2 underpads, if procedure is performed in bed Plastic bag for used supplies Procedure Guidelines S/U Initials S/U Initials 1. Perform your beginning procedure 2. Assist the patient to the bathroom if the procedure will be done there. If it will be done in bed, position the underpad to prevent soiling. Position a second underpad on a chair next to the bed, and place the bedpan on it.

31 3. Hang the irrigation bag approximately 20 inches above the patient. The bottom of the bag should be at about the patient s shoulder level to prevent water from entering the bowel too quickly. 4. Prime the irrigation tubing, if this was not done when you filled the bag. 5. Apply gloves. Procedure Guidelines S/U Initials S/U Initials 6. Remove the colostomy bag and discard according to facility policy. 7. Apply the irrigation sleeve, securing it with the adhesive backing or an appliance belt. 8. Place the open end of the irrigation sleeve in the toilet or a bedpan on a chair next to the bed. If the procedure is done on the toilet, cut the bottom of the sleeve, if necessary, so it hangs just above water level. If it hangs into the water, it may not drain. Avoid cutting it too short, as this increases the risk of splashing. 9. Lubricate the small finger of your gloved hand. 10. Gently insert your lubricated finger into the stoma. The stoma will tighten when you insert your finger, but will relax shortly. Determine the bowel angle with your finger. You will insert the irrigation cone at this angle. 11. Lubricate the cone on the irrigation set well. 12. Insert the cone gently, in the direction of the bowel. Although you must be gentle when you insert the cone, it must fit securely.

32 Procedure Guidelines S/U Initials S/U Initials 13. Unclamp the tubing and allow the fluid to run in slowly. Adjust the rate of flow with the roller clamp, or pinch the tubing with your fingers to prevent the fluid from entering too fast. The bag of fluid should flow in over 10 to 15 minutes. If the patient complains of abdominal cramping, stop the flow of solution, leaving the cone in place. Cramping may occur if there is air in the tubing, if the flow is too rapid, if the water is too cold, or because the bowel is ready to empty. Troubleshoot the system, then begin the solution again. Advise the patient to take slow, deep breaths when the fluid is infusing. 14. When the bag is empty, remove the cone. Try to remove the cone when there is water in the tubing, to avoid injecting air. Close the tip of the sleeve if the patient will be ambulating. 15. If the patient will be ambulating, remove gloves and wash your hands. Discard your gloves according to facility policy. 16. If permitted by facility policy, and the patient is ambulatory, allow him or her to ambulate for 15 to 20 minutes, until evacuation occurs. The ambulation will stimulate peristalsis in the bowel. In some facilities, the patient remains stationary for another 15 to 20 minutes to allow the fluid to drain. The nonambulatory patient can lean forward and massage the abdomen to stimulate evacuation. Know and follow facility policy. 17. Apply clean gloves, if gloves were removed. 18. If the solution was ordered to completely cleanse the bowel for tests or procedures, repeat the irrigation until the fluid returns clear. 19. After the irrigation is complete, remove the irrigation sleeve. Discard the disposable sleeve. If reusable, rinse it well and hang to dry.

33 Procedure Guidelines S/U Initials S/U Initials 20. Wash the skin surrounding the stoma with warm water. Pat dry. Apply barrier product, if ordered. 21. Apply a clean appliance. 22. Perform your procedure completion Instructor Signature Student Signature