A colostomy is a surgical procedure that redirects the colon through an opening in the abdominal wall, known as a stoma, allowing waste to exit the body into an external pouching system. Certified Nursing Assistants (CNAs) play an important part in maintaining this appliance, specifically by emptying the pouch to ensure patient comfort, hygiene, and dignity. Proper technique helps prevent skin irritation, manage odor, and avoid leakage that could lead to discomfort or infection. Emptying the colostomy pouch falls within the scope of practice for CNAs, who are often the frontline caregivers responsible for this routine task.
Gathering Supplies and Ensuring Safety
Before initiating the procedure, the CNA must perform hand hygiene and don appropriate personal protective equipment (PPE), typically non-sterile gloves, to adhere to standard precautions. A protective barrier, such as disposable underpads or “chucks,” should be placed beneath the pouch and over the patient’s clothing or bedding to catch any accidental spills. Essential supplies must be gathered and placed within easy reach, including a graduated cylinder or bedpan to collect the effluent, toilet paper or gauze squares for cleaning, and a washcloth for post-procedure cleanup.
The patient’s privacy is ensured by closing the door or pulling the bedside curtain, and the procedure is explained clearly to reduce anxiety and encourage cooperation. Proper patient positioning is necessary for easy access and drainage, often with the patient sitting on the toilet or chair, or lying in a semi-reclined position if a bedpan is used. The bag should be emptied when it is approximately one-third to one-half full, as a heavier pouch can compromise the seal and cause leakage.
Step-by-Step Guide to Emptying the Pouch
The first step in emptying a drainable pouch is to carefully unfasten or unclamp the tail closure (e.g., plastic clip, integrated closure, or Velcro system). Before unclamping, the bottom of the pouch should be folded upward to form a cuff; this keeps the exterior cleaner and minimizes the risk of soiling the closure device. The open end of the pouch is then directed into the measuring receptacle, which is held close to the abdomen to allow gravity to assist the flow of contents.
As the effluent drains, the CNA may gently squeeze or “milk” the pouch from top to bottom, ensuring all contents are fully expelled into the container. This action helps to clear any thick or semi-formed stool remaining near the spout. After the bulk of the contents has drained, the inner surfaces of the tail must be wiped clean using toilet paper or gauze. This cleaning step is important for odor control and to prevent residue from interfering with the closure seal.
The cleaning process should focus solely on the inside and edges of the tail, avoiding contact with the skin barrier or the stoma itself. Once the spout is thoroughly cleaned, the closure device is secured again, either by reattaching the clip or sealing the integrated system. Confirm that the seal is tight and secure to prevent leakage onto the patient’s clothing or skin. Throughout this process, the CNA should observe the output, noting its color, consistency, and amount, as this provides important information about the patient’s gastrointestinal function.
Patient Comfort and Post-Procedure Documentation
Immediately after the pouch is emptied and secured, the area is cleaned to restore hygiene and comfort. The used toilet paper or gauze, along with the soiled protective pad, is discarded into the designated waste receptacle. If a bedpan or graduated cylinder was used, its contents are emptied into the toilet, and the receptacle is rinsed and cleaned according to facility protocol.
Once the initial cleanup is complete, the CNA removes soiled gloves, performs hand hygiene, and dons a fresh pair of gloves. The exterior of the pouch is wiped down with a clean, damp washcloth to remove external soiling, further controlling odor and maintaining skin integrity. The patient’s clothing and bedding are adjusted to ensure they are dry, clean, and wrinkle-free, promoting maximum comfort.
Before concluding the procedure, the amount of output is measured accurately using the graduated cylinder for Intake and Output (I&O) charting. The CNA must then document the procedure, recording the time, the volume of the output, and observations regarding the stool’s characteristics (e.g., formed, semi-liquid, or liquid).
Additionally, the CNA observes the peristomal skin (the skin immediately surrounding the stoma) for any signs of irritation, redness, or breakdown. Any concerning findings must be reported to the supervising nurse for further assessment.