Modern medicine has a variety of means in order to save the life of the patient. But there are still methods in medical practice that are still known to ancient healers. One of them is such a surgical intervention, which has the name "stoma". What is it, what is the testimony, how is it carried out - you will learn about all this by reading the material. We also paid special attention to caring for different types of stoma, since often such manipulations are carried out at home, and the quality of their conduct affects the healing process.
The concept of ostomy in medicine
Stoma - what is it in surgery? This is a special hole that is produced surgically by the patient for medical reasons. Most often, a stoma of the intestine, bladder is carried out, less often - trachea. What is a stoma? This is a hole that communicates a hollow organ with an external catheter or tube in order to normalize the patient's condition after surgery or other manipulations. The most common operation is the formation of an opening in the abdominal cavity. In this case, the indication for ostomy is the removal of the intestine (or part of it).
Stoma - is it temporary or lifelong, is such a condition of a person considered a disability? An artificial hole is not considered a disease and in itself is not a reason for disability, as it does not exclude the possibility of a full life. Having learned how to use the colostomy bag or other devices for stoma care properly, a person can fully work, study, play sports, build a family. But often it is the indications for ostomy that are a serious pathology, leading to disability and the patient's limited abilities.
Ostomy can be temporary, for example, such an operation is performed to rehabilitate the patient after surgery or a severe infection that interferes with the functioning of the excretory system. After restoration of impaired functions, the stoma can be removed surgically. But in some situations, for example, after removal of the intestine, a stoma is a necessary condition for ensuring the normal functioning of the patient.
Indications for ostomy
Indications for ostomy surgery are congenital pathologies, injuries, surgeries that led to the complete or partial removal of excretory organs. Accordingly, the normal operation of damaged systems is disrupted. Stoma helps restore the body's natural functions. In what cases there is a need for complete or partial removal of the intestine, bladder or trachea, after which an artificial opening is required:
- The first place is occupied by cancer of these organs, which leads to surgical intervention to remove damaged tissue.
- Injuries.
- Nonspecific and ischemic colitis.
- Incontinence.
- Radiation and chemical damage.
- Other diseases that violate the performance of organs.
It happens of different types, shapes and sizes of stoma. What it is? The photo below shows an intestinal artificial fistula.
Types of ostomy
Stomas are distinguished depending on the area of surgical intervention:
- gastrostomy;
- intestinal: ileostomy, colostomy;
- tracheostomy;
- epicystostomy.
The shape is convex and retracted. There are single-barrel and double-barreled. Depending on the duration of use: temporary and permanent.
According to statistics, intestinal stoma is more common than other types.
Each species is distinguished by the principle of formulation, the mode of action and needs a certain care and rehabilitation period.
Tracheostomy: indications, features
A tracheostomy is an artificially created hole in the neck with a tube removed, which is installed in order to recreate the damaged respiratory functions of a person. In case of violations of the respiratory system, the inability to perform an independent act of inhalation-exhalation, the patient often urgently performs stoma of the trachea.
Such a stoma is a rather difficult formation to care for. It gives a lot of discomfort to a person. Especially if installed forever. Open airways facilitate the easy penetration of viruses and bacteria, which leads to various diseases and weakens the overall immunity of a person. In addition, the artificial "trachea" does not moisturize or warm the inhaled air, which also contributes to the penetration of infections and the risk of various diseases. Therefore, it is necessary to control the quality of the inhaled air from the outside - carefully monitor the temperature of the air in the room in which the patient is located. To moisturize, use special devices or apply a wet towel to the surface of the tracheostomy tube, changing the tissue as it dries.
The patient should not engage in active sports, swim (especially dive under water). Any, even slight, ingress of water into the tube can lead to respiratory arrest.
Is a tracheal stoma permanent? More often than not. It can be permanent only if the trachea is removed (which is extremely rare) or if a person is completely unable to breathe independently, when such a condition cannot be treated and restored.
A temporary tracheostomy is established during surgery to give anesthesia, if it is not possible to anesthetize using other methods.
Tracheostomy Care
Tracheostomy requires regular proper care:
- Every few hours, the outer tube must be washed with a solution of sodium bicarbonate (4%) to remove residual mucus from the cavity.
- To prevent the formation of skin inflammations and diseases, it is necessary to treat the area around the tracheosome. For this, cotton balls are moistened with cotton wool with a solution of furatsilin. Then, using tweezers, they blot the skin area around the tracheostomy with them. After that, zinc ointment or Lassar paste is applied. Processing is completed by applying sterile wipes. Fix the bandage with a band-aid.
- It is periodically recommended to suck out the contents of the trachea, as often patients with a tracheostomy cannot fully clear their throat, which leads to stagnation of mucus and, as a result, difficulty breathing. To perform this manipulation, you need to sit the patient on the bed and conduct a manual massage of the chest. Pour 1 ml of sodium bicarbonate (2%) through the tube into the trachea in order to thin the mucus. Then you need to insert a tracheobronchial catheter into the tube. By attaching a special suction, remove the mucus of their trachea.
Proper care of the stoma is extremely important, since a violation of its functions can lead to respiratory arrest.
Gastrostomy
A gastrostomy is removed from the abdominal region to provide a person with nutrition in cases where the patient cannot take food on his own. Thus, liquid or semi-liquid nutrition is injected directly into the stomach. Most often, this condition is temporary, for example, with serious injuries and in the postoperative period. Therefore, the gastrostomy in rare cases is constant. When restoring the function of self-eating, the gastrostomy closes surgically.
How to care for a gastrostomy?
Gastric stoma - what is it, in what cases is it established? When a gastrostomy is applied, a rubber tube is brought out, designed specifically for transporting food to the stomach. During feeding, a funnel is inserted for convenience, and in between meals, the tube is clamped with a thread or clothespin.
With a gastrostomy, the main goal of care is to treat the skin around the hole in order to prevent skin inflammation, diaper rash, rash. The area of skin around the stoma is treated first with a solution of furatsilina using cotton balls and tweezers, and then with alcohol. Then it is lubricated with aseptic ointment. The procedure ends with the application of a bandage.
Epicystostoma: indications, care
Epicystoma is removed from the bladder to the surface of the abdominal wall using a special catheter. Indications for the appointment of such manipulation is the patient's inability to urinate naturally for various reasons. Epicystostomas are temporary and permanent.
Such a stoma requires special observation. What does it mean? Care for epicystostomy is quite complicated: you need to be able to not only clean the catheter and care for the skin around it, but also rinse the bladder and replace the urinal. Therefore, it is better if such procedures are carried out by a qualified nurse or nurse.
Epicystoma introduces certain limitations in the life of the patient. So, the patient is not recommended to swim, play sports, for a long time to be at low air temperature.
Care must be taken to monitor the cleanliness of the catheter and the area of skin around it. Twice a day, the skin should be washed with soapy water, and the outer tube and urinal should be washed as it becomes clogged.
It is important to monitor the quantity and quality of discharge. There should be no pus and blood - with such symptoms it is urgent to seek medical help. Consultation with a specialist is also required if the patient's body temperature rises, urine volume decreases, its color changes, the catheter is damaged or its position is disturbed, and pain in the lower abdomen is present.
Intestinal stomas: types
Intestinal stoma - what is it, what types exist? This type of hole is also called "artificial intestines." Are established at disturbances of work of the corresponding body after various surgical operations. For example, when removing the intestine or part of it. In this case, a constant stoma is placed. And, for example, after a hernia removal operation, which led to the body's inability to cope with the excretion of feces in a natural way, surgeons perform an ostomy of a temporary nature.
Excretion on the abdominal wall of the colon is called a colostomy. And thin - ileostomy. Outside, both species represent a section of the intestine brought to the front wall of the abdominal cavity. Such a stoma is a fistula in the form of a rosette, on which a kalopriemnik is installed outside.
In order to prevent postoperative complications and the spread of an unpleasant odor, an intestinal stoma needs regular care.
How to care for intestinal stomas?
With intestinal stomas, more often than with other types, the development of complications associated with improper care is observed. Contrary to popular belief, kolopriemniki need to be changed only as necessary, since frequent changes lead to irritation and damage to the stoma and the area around the hole. Depending on the type of kalopriyemnik it should be changed with such regularity:
- when the contents of the one-component system has reached half or the patient has discomfort from the receiver bag;
- with a two-component system, the adhesive plate is left for 3 days.
Directly a bag for receiving feces put on at the time of defecation. After which they are immediately removed, the bowel stoma is cleaned with a soapy solution, and it is dryly blotted with napkins. Then they are lubricated with the “Stomagesiv” preparation, and the intestinal mucosa with Vaseline to prevent cracks. A napkin is folded in several layers, a bandage is fixed with a band-aid, and then linen is put on. Stoma care is an important component of a patient’s recovery.
Complications
Complications after an ostomy operation - the situation is quite common. Stoma after surgery requires careful medical supervision and proper care. What problems may arise, how to deal with them and prevent them, we will consider in more detail:
- Dermatitis of the periosteum (skin irritation). Irritation can occur due to improper care, inappropriate means and preparations, improper catheter strengthening. Burning, itching, rashes appear.
- Bleeding from an artificial hole can be caused by injury to the mucous membrane with a catheter or tube. Typically, such injuries do not cause concern for doctors and pass on their own. But if the bleeding is profuse and does not stop within a few hours, urgent medical attention is needed.
- Retraction (stoma retracts inward). This condition makes it difficult to use kalopriemniki, the outer parts of the tubes and catheter. Complicated and skin care. Specialist consultation required.
- Stenosis (narrowing of the opening). If the stoma is narrowed to such an extent that its functions are impaired (feces do not pass with an intestinal stoma or breathing is difficult with a tracheostomy), then surgical intervention is necessary. The narrowing of the hole occurs due to inflammatory processes.
- The prolapse of the intestinal stoma by several centimeters does not violate its functions and does not affect the patient's condition. But there are cases of complete loss. Often this happens with increased physical exertion, coughing. Depending on the situation, the stoma that has fallen out can be independently adjusted. With frequent loss, you should consult a doctor.
A stoma is not a disease, but, nevertheless, a person in this condition needs careful treatment and care. Both temporary and permanent stomas require compliance with medical prescriptions. Choose the care products recommended by the specialist for the type, form and brand, since only the surgeon can determine which type of receiver and catheter, paste and ointment will be most effective and comfortable for the patient in a particular medical case. When choosing, the size and type of the hole, its purpose, skin type, patient's tendency to allergies and many other related factors are taken into account. Do not self-medicate - strictly observe the appointment of a specialist.