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Irrigation for Ileostomy obstruction (blockage)


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PostPosted: Thu Jul 23, 2009 9:42 pm    Post subject: Irrigation for Ileostomy obstruction (blockage) Reply with quote

Yesterday afternoon, shortly after lunch, I was surprised by a sudden blockage. I was so busy that I didn't even realize that I had no output ALL day. It was 3:00 pm. Cramping, nausea, pain, and belly distension had me paralyzed in pain.

This was my first obstruction that was not post operative adhesion related so I was shocked but not scared.

I massaged the area. Drank hot tea. Prayed. Cried. Moaned. Then crawled to the phone, went to the pantry, grabbed a big syringe that is really used for cake decorating, a plastic cup, and crawled to the bathroom. Then I called a friend to come over in case I had to go to the ER.

I called my GI and we made an ER plan if what I was about to do didn't work. I ran the shower. Pulled off the pouch. Filled the cup with warm water. Performed a stomal enema.  I applied a little too much pressure and WOW WEE did it hurt. I almost passed out.  

I just wanted to try to do this at home. I knew the chances of it clearing up before I got to the ER was pretty high so what's the point of suffering in that waiting room?

Sure enough about an hour later the pressure subsided and there was a very slow gradual output.

I followed up today.  They said it was ok to do some irrigation but it only reaches about 5 inches in.  Good to know.

Dr. recommended using a real enema (not the cake decorator) and allowing gravity to flow the water in rather than applying pressure. I recommend warming it up first.  

It was a pretty traumatic episode. I didn't care for it at all!

So I recommend keeping a stock of one or two bottles in supply box. The cake decorator syringe worked but now I lost one of my fave kitchen gadgets!
Peace y'all!
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 Guest





PostPosted: Fri Jul 24, 2009 1:48 pm    Post subject: Irrigation kit Reply with quote

coloplast makes an economical "kit" that even has a built in temp gauge to get the water temp exactly right, it fastens on over your existing 2 piece appliance base. just in case you want to be totally prepared next time.

http://www.jrsmedical.com/OSTOMY/IRRIG_ITEMS/nav.aspx
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 eddie





PostPosted: Sat Jul 25, 2009 11:49 am    Post subject: Reply with quote

I have an ileo. try theses instructions next time, good luck
eddie
HOW TO TREAT ILEOSTOMY BLOCKAGE

Symptoms:
Thin, clear liquid output with foul odor; cramping
abdominal pain near the stoma; decrease in amount of or

dark-colored urine, abdominal and stomal swelling.

Step One: At Home

1. Cut the opening of your pouch a little larger than normal because

the stoma may swell.

2. If there is stomal output and you are not nauseated or vomiting,

only consume liquids such as Coke, sports drinks, or tea.

3. Take a warm bath to relax the abdominal muscles.

4. Try several different body positions, such as a knee-chest

position, as it might help move the blockage forward.

5. Massage the abdomen and the area around the stoma as this might

increase the pressure behind the blockage and help it to “pop

out.” Most food blockages occur just below the stoma.

Step Two: If you are still blocked, vomiting, or have no stomal

output for several hours:

1. Call your doctor or WOC/ET Nurse and report what is

happening and what you tried at home to alleviate the

problem. Your doctor or WOC/ET Nurse will give you instructions

(ex., meet at the emergency room, come to the of
fi ce). If you are
told to go to the emergency room, the doctor or WOC/ET Nurse

can call in orders for your care there.

2. If you cannot reach your WOC/ET Nurse or surgeon and

there is
no output from the stoma, go to the emergency
room immediately.

3.
IMPORTANT: TAKE THIS CARD WITH YOU TO THE EMERGENCY
ROOM AND GIVE IT TO THE PHYSICIAN.

4.
IMPORTANT: TAKE ALL OF YOUR POUCH SUPPLIES
(eg., pouch, wafer, tail closure, skin barrier spray, irrigation

sleeve, etc.)

United

Ostomy

Associations of

America, Inc.

United Ostomy Associations of America

P.O. Box 66

Fairview, TN 37062

800-826-0826, www.uoaa.org

EMERGENCY ROOM STAFF:

ILEOSTOMY OBSTRUCTION

Symptoms:
No stomal output; cramping abdominal pain; nausea
and vomiting; abdominal distention, stomal edema, absent or faint

bowel sounds.

1. Contact the patient’s surgeon or WOC/ET Nurse to obtain history

and request orders.

2. Pain medication should be initiated as indicated.

3. Start IV
fl uids (Lactated Ringer’s Solution/Normal Saline)
without delay.

4. Obtain
fl at abdominal x-ray or CT scan to rule out volvulus
and determine the site/cause of the obstruction. Check for local

blockage (peristomal hernia or stomal stenosis) via digital

manipulation of the stoma lumen.

5. Evaluate
fl uid and electrolyte balance via appropriate
laboratory studies.

6. If an
ileostomy lavage
is ordered, it should be performed by a
surgeon or ostomy nurse using the following guidelines:

• Gently insert a lubricated, gloved
fi nger into the lumen of the
stoma. If a blockage is palpated, attempt to gently break it up with

your
fi nger.
• Attach a colostomy irrigation sleeve to the patient’s two-piece

pouching system. Many brands of pouching systems have

Tupperware®-like
fl anges onto which the same size diameter
irrigation sleeve can be attached. If the patient is not wearing

a two-piece system, remove the one-piece system and attach a

colostomy irrigation sleeve to an elastic belt and place it over

the stoma.

• Working through the top of the colostomy irrigation sleeve, insert

a lubricated catheter (#14–16 FR) into the lumen of the stoma

until the blockage is reached. Do not force the catheter.

Note: If it is possible to insert the catheter up to six inches, the
blockage is likely caused by adhesions rather than a food bolus.

• Slowly instill 30–50 cc NS into the catheter using a bulb syringe.

Remove the catheter and allow for returns into the irrigation sleeve.

Repeat this procedure instilling 30–50 ccs at a time until the

blockage is resolved. This can take 1–2 hours.

7. Once the blockage has been resolved, a clean, drainable

pouch system should be applied. Because the stoma may be

edematous, the opening in the pouch should be slightly larger


than the stoma.
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 Guest





PostPosted: Sat Jul 25, 2009 4:14 pm    Post subject: Reply with quote

Hi Eddie,
Minus #1 which is impossible when the appliance is already on, this is exactly what I did.
I did use the UOAA website.
I am all better now!
I did order the cards and will keep in my emergency kit.
Great info the for the rest of the gang.
Thanks for sharing it.
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 Guest





PostPosted: Sun Jul 26, 2009 2:36 pm    Post subject: Re: irrigation kit Reply with quote

[quote="mild_mannered_super_hero"]coloplast makes an economical "kit" that even has a built in temp gauge to get the water temp exactly right, it fastens on over your existing 2 piece appliance base. just in case you want to be totally prepared next time.

http://www.jrsmedical.com/OSTOMY/IRRIG_ITEMS/nav.aspx[/quote]

wow I have always seen these but I assumed only Colostomy users would need this.
I should pick one of these up too but will get with my WONC nurse to train me how to use it without being stupid.
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 Guest





PostPosted: Sun Jul 26, 2009 5:51 pm    Post subject: Turkey baster Reply with quote

yes check with the nurse first......but its better than a turkey baster, or cake decorater!!!!
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 mooza





PostPosted: Mon Jul 27, 2009 3:17 am    Post subject: Reply with quote

argggg why didnt i read this a week ago i just got out of hospital with a bowel obstruction i didnt know us ieleo's could or should do this(irrigate) a whole week in hos has felt like a month i've had crohn's would this be safe or dangerous sounds the latter to me i was going to ring an Ambulace but felt silly i waited about 3minutes in hospital and was quickly admitted never eatin coconut ever ever again agony is sooo right was vomiting water then that was gone. The doc said it was also from scar tissue i do get a few blockages but after massage and lying on my side can help i never though i would end up in hospital shouldnt have waited 24hours ..Was worried they would operate was very lucky so can any one tell me if this is ok 4 crohns people ..Also am going to Malasia for 8 days was worried i couldnt go these things happen at the most inconvenient times lol well cheers guys love mooza Down Under Melbourne..
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 Shitbag





PostPosted: Mon Jul 27, 2009 10:00 am    Post subject: Reply with quote

Hi Angie; I know your pain. When I have a blockage I sometimes irrigate using a feeding catheter my surgeon gave me. It is quite small and flexible and has a rounded end so I can get it a fair distance up my ileum. Works quite well. On a brighter note, how is your luthier cource going, built an instument yet? How is Larrivee doing? I love those guitars!dpottage(at) csolve.net
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 Whoa
Nurse




PostPosted: Mon Jul 27, 2009 2:24 pm    Post subject: Reply with quote

Hi all

I'd like to clarify a bit  re: ileostomies, suspected food blockages and irrigation.

First, irrigating an ileostomy should ONLY be done if there is a suspected food blockage.  It is not a routine form of management.  Whoever does it needs to be knowledeable about the stoma, that it is small bowel, etc.

It can be hard to distinguish if it is a food blockage, ileus or adhesions.  The best advice:  if you are having significant pain for more than 2 hours, (whether or not you tried to relieve the obstruction), please go to the emergency room and get an xray.   Doctor's/nurses  don't always return calls immediately....If you are hurting badly and they don't respond...GO to the ER!

Irrigation:  do NOT use a fleets/rigid enema or tubing.   It can perforate your bowel; this is a medical emergency if perforated.   It happened years ago to one of my patients.   You must use either a cone made for irrigation or soft flexible catheter.  If you don't have an irrigation sleeve, no problem.  Just empty your pouch more frequently.  If you have frequent blockages from food, chew better, stop eating the offending food.  If this continues, I recommend checking with your surgeon or GI MD to check out if adhesions/strictures or other issues going on.



Eddie, great post from UOAA page!  Reasonable and good protocol.  Thanks for posting that!
_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
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 Guest





PostPosted: Tue Jul 28, 2009 9:59 pm    Post subject: Reply with quote

Whoa,
I am fully recovered and past the emergency. I just don't feel comfortable doing the irrigation.  I was desperate and the water could only go in about two - three inches which wasn't much help. In the end everything passed but now looking back, I just don't feel comfortable doing that ever again.
I will go straight to the ER next time.
Thank you for this post.
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 Whoa
Nurse




PostPosted: Tue Jul 28, 2009 10:09 pm    Post subject: Reply with quote

Hi imperfect
I'm glad you are ok and recovered.  I think you were smart to look stuff up, and pretty brave!  

Even with a flexible soft cath, the water often spurts out;  if using a cone meant for irrigating a stoma and an irrigation set, I worry folks will put too much fluid in their stoma.

I am glad the info is out there on the sight.  For me, as a nurse....when someone calls with obstructive type symptoms, I will always tell them go to the ED unless they are a long term ostomate who has been down that road before.......it is the safest thing to do for the patient since I'm not there to check.  Not to mention the security of my nursing license
_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
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 StarUK





PostPosted: Thu May 09, 2013 7:58 am    Post subject: Reply with quote

thanks for posting this and everyone's responses i just got out of hospital at 2am this morning after my first blockage not only was it painful i was absolutely terrified. I am sat here with a very tender stomach i guess its from the cramping but i am pushing fluids and praying i don't have to go through his again
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