- Determination of optimal site; assessed in a lying, sitting and standing position
- Key Points
- Positioning issues: contractures, posture, mobility e.g. wheelchair confinement, use of walker etc.
- Physical considerations: large/protruding/pendulous abdomen, abdominal folds, wrinkles, scars/suture lines, other stomas, rectus muscle, waist line, iliac crest, braces, pendulous breasts, vision, dexterity, presence of hernia.
- Patient considerations: Diagnosis, history of radiation, age, occupation
- other: Surgeon and patient preference, type of ostomy or diversion, anticipated stool consistency.
- Multiple stoma sites: Mark fecal and urinary stomas on different horizontal planes/lines.
Procedure:
- Marking pen, surgical marker, transparent film dressing, flat skin barrier
- Carefully examine abdominal surface. Begin with patient fully clothed in sitting position with feet on floor. Observe the presence of belts, braces and any other ostomy appliances.
- Examine patient’s exposed abdomen in various positions (standing, lying, sitting and bending forward) to observe for creases, valleys, scars, folds, skin turgor and contour.
- Draw an imaginary line where the surgical incision is going to be. Choose a point approximately 2 inches from the surgical incision where 2 – 3 inches of flat adhesive barrier can be placed.
- With patient lying on back identify the rectus muscle. (This can be done having the patient do a modified sit up (raise the head up off the bed). Placement within the rectus muscle can help to prevent peristomal hernia formation and/or prolapse.
- Choose an area that is visible to the patient, and if possible below the belt line to conceal the pouch.
- Large abdomen; choose the apex of the mound or in extremely obese, place in the upper abdominal quadrants.
- It may be desirable to mark sites on the right and left sides of the abdomen to prepare for a change in the surgical outcome.
- Clean the desired site with alcohol and allow to dry. Then proceed with marking the selected site with a surgical marker / pen. You may cover with transparent film dressing if desired to preserve the mark.
- Once marked have the patient assume sitting, bending and lying position to assess and confirm best choice. It is important to have the patient confirm they can see the site.