Colostomy Irrigation 

Purpose: 

To cleanse the bowel and establish a regular bowel habit or time for evacuation. 

Policy: 

Colostomy irrigations are done only with a physician’s order, which must include the type of solution to be instilled. Colostomy irrigation is to be performed by a licensed nurse. 

Procedure: 

        Preparation: 

• Gather equipment: irrigation set and solution ordered (e.g., 1000cc of normal saline or warm water). 
• Position the resident: 
• If able, position the resident on a commode or toilet. 
• If not, position the resident in a sitting position at the edge of the bed or lying on their side. Removing Ostomy Appliance: 

Remove the ostomy bag/appliance. 

Setting Up for Irrigation: 

•  Place a plastic protector under the ostomy stump and form a trough with the distal end in the bedpan or toilet. 
•  Place a bedpan to collect return solution if the resident is in bed. 

Priming and Lubrication: 

• Prime the tubing with the solution. 
• Lubricate the tip of the irrigation tubing. 

Insertion and Irrigation: 

• Insert the tubing gently into the stoma. If the resident complains of pain or there is resistance in passing the irrigating tip, rotate it gently. If pain persists, discontinue the procedure and notify the physician. 
• Open the clamp and instill approximately 250cc of the solution, allowing it to flow slowly into the colon. It should take approximately 10 minutes for the solution to flow into the colon. 

Monitoring Return Flow: 

The return flow will run into the bedpan or toilet bowl. 

Continue the procedure until the return flow is clear. 

Post-Irrigation Care: 

• Remove the drainage bag or irrigation sleeve. 
• Clean the area around the stoma. 
• Apply a skin-protecting agent (if applicable) around the stoma. 
• Apply a new ostomy bag/appliance. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the procedure, including the resident’s response and any observations, in their medical record. 

• Note any complications or difficulties encountered during the procedure. 

• Regularly review and update techniques for colostomy irrigation according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper colostomy irrigation procedures to ensure resident safety and effective bowel management. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.