PROCEDURAL GUIDELINES (to accompany Chapter 47)

Irrigating a Colostomy

A colostomy is irrigated to empty the colon of feces, gas, or mucus, cleanse the lower intestinal tract, and establish a regular pattern of
evacuation so that normal life activities may be pursued. A suitable time for the irrigation is selected that is compatible with the patient's
posthospital pattern of activity (preferably after a meal). Irrigation should be performed at the same time each day.
Before the procedure, the patient sits on a chair in front of the toilet or on the toilet itself. An irrigating reservoir containing 500–1500 mL
of lukewarm tap water is hung 45–50 cm (18–20 inches) above the stoma (shoulder height when the patient is seated). The dressing or
pouch is removed. The following procedure is used; the patient is helped to participate in the procedure so that he or she can learn to
perform it unassisted.

Equipment
• Irrigating sleeve or sheath • Irrigating catheter or cone and tubing • Lubricant • Clamp • Mild soap • Cloth or towel
• New colostomy dressing or appliance

Implementation
Nursing Actions Rationale

1. Perform hand hygiene; then, apply an irrigating sleeve or
sheath to the stoma. Place the end in the commode.
2. Allow some of the solution to flow through the tubing and
catheter/cone.
3. Lubricate the irrigating cone and gently insert it into the stoma
(Fig. A). Insert the cone into the stoma and hold it gently, but
firmly, against the stoma to prevent backflow of water.
4. Allow water to flow slowly while advancing catheter (Fig. B).
5. Allow tepid fluid to enter the colon slowly. If cramping occurs,
clamp off the tubing and allow the patient to rest before pro-
gressing. Water should flow in over a 5—10-minute period.
6. Hold the cone in place 10 seconds after the water has been
instilled, then gently remove it (Fig. C).
1. Hand hygiene is necessary before any intervention to
decrease the likelihood of transmitting a hospital-associated
infection. Application of the sleeve or sheath helps control
odor and splashing and allows feces and water to flow
directly into the commode.
2. Air bubbles in the setup are released so that air is not intro-
duced into the colon, which would cause crampy pain.
3. Lubrication permits ease of insertion of the cone. A cone is
used to prevent internal damage if a catheter is used.
4. A slow rate of flow helps to relax the bowel.
5. Painful cramps usually are caused by too rapid a flow or by
too much solution; 300 mL of fluid may be all that is needed
to stimulate evacuation. Volume may be increased with
subsequent irrigations to 500, 1000, or 1500 mL as needed
by the patient for effective results.
6. This minimizes or eliminates spillage of water.

A C

7. Allow 10–15 minutes for most of the return; then, dry the bot-
tom of the sleeve/sheath and attach it to the top, or apply the
appropriate clamp to the bottom of the sleeve.
8. Leave the sleeve/sheath in place for 30–45 minutes while the
patient gets up and moves around.
9. Cleanse the area with a mild soap and water; pat the area dry.
10. Replace the colostomy dressing or appliance.
Adapted from Bauer, C., Arnold-Long, M., & Kent, D. J. (2016). Colostomy irrigation to maintain continence: An old method revived. Nursing 2016,
46(8), 59–62.
7. Most of the water, feces, and flatus will be expelled in
10–15 minutes.
8. Ambulation stimulates peristalsis and completion of the
irrigation return.
9. Cleanliness and dryness will provide the patient with hours
of comfort.
10. The patient should use an appliance until the colostomy is suf-
ficiently controlled. A dressing may then be all that is needed.

From Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14th Edition. All Rights Reserved.

LWBK1592-CH47_online-02.indd 1 7/25/17 5:52 PM