a. An ileostomy is a surgically created, artificial opening (stoma) into the small
bowel (ileus) through the abdomen. The stoma is located low on the abdomen (lower
quadrants.) Most ileostomies are performed because of inflammatory bowel disease.
b. An ileostomy may be temporary or permanent. If temporary, the bowel is left
intact. In a permanent ileostomy, the colon is removed.
c. Unlike a colostomy, an ileostomy cannot be regulated. The fecal contents of
the ileum are fluid, and drain continuously. For this reason, an ileostomy patient must
always wear an appliance.
d. New surgical techniques are being used to create what is called a "continent"
ileostomy. In these procedures, a portion of the ileum is used to create a pouch with a
nipple valve. Pressure from feces entering the pouch causes the valve to close,
preventing leakage of gas or feces from the stoma. The pouch can be easily emptied
by insertion of a catheter and gravity drainage. Because the pouch is continent, the
patient does not need to wear an appliance.
1-47. NURSING IMPLICATIONS FOR THE PATIENT WITH AN ILEOSTOMY
a. There are many commercial ileostomy appliances available. Each patient
should be fitted with the style that is most comfortable and convenient for that patient's
lifestyle. Appliances should be applied, removed, and cleaned in accordance with the
b. The appliance worn over the stoma of a conventional, or "incontinent,"
ileostomy must be drained several times daily.
For convenience, this can be done at the same time the patient urinates.
(2) Pouches are equipped with an emptying spout at the bottom, allowing
the contents of the pouch to be drained directly into the toilet.
c. An appliance can normally be left in place for 2-4 days before being changed.
A regular schedule for changing the appliance should be established to avoid leakage.
d. Each time the appliance is changed, the peristomal skin should be washed
with soap and water and inspected for irritation or breakdown.
(1) Although each patient will develop his own routine for changing the
appliance, it is best to perform this care when the ileostomy is quiet. For example:
before a meal, 2 hours after a meal, or at bedtime.