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Stoma marking on challenging

abdomens

Amelia Agostinelli BSN, RN, CWCN,COCN,CCCN

Objective

• 1. Select the optimal stoma site on the challenging

abdomen.

Introduction

• 1. Assess abdomen• Sitting – standing – bending-lying down

• 2. Positioning issues• Protruding/pendulous, creases, scars, hernia

• 3. Physical considerations• Wheelchair – vision - dexterity

• 4. Emotional impact

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Sitting

Standing

Lying down

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Summit of the Infraumbilical mound –away from the umbilicus – within the rectus muscle

Perfect site

Summit of the Infraumbilical mound Away from the umbilicus

Within the rectus muscle

Stoma marking with hernia complication. Where do I mark this abdomen?

Abdominal view lying down

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Marked in RLQ

Multiple scars

Now where do I go?

Assess while standing. Note changes in abdominal contours

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3 options provided to surgeon

Abdominal folds

Again, note changes in abdominal contours when patient is seated.

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Only 1 good location

Wheelchair and creases – Oh my

3 options provided to surgeon

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Effects of poorly placed stoma

2Note, stoma placed well outside of rectus muscle

1 2

3 4

References

• ASCRS and WOCN Joint Position Statement on the Value of

Preoperative Stoma Marking for Patients Undergoing Fecal

Ostomy Surgery (2007). J Wound Ostomy Continence Nurs.; 34(6)

• Carmel, J., Goldberg, M. (2004). Preoperative & postoperative

management. In Colwell, Goldberg, & Carmel (Eds) Fecal &

urinary diversions: Management principles. St. Louis, MO: Mosby

• Erwin-Toth, P. (2003). Ostomy pearls. Advances in Skin &

Wound Care; 16(3)

• Erwin-Toth, P., Stricker, L., & Rijswijk, L. (2010). Peristomal skin

complications. AJN February; 110(2)