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9/26/2014
1
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
9/26/2014
3
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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4
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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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)