Preoperative stoma site marking for fecal diversions (ileostomy and colostomy): position statement of the Canadian Society of Colon and Rectal Surgeons and Nurses Specialized in Wound, Ostomy and Continence Canada

Abstract

Background: Every year, about 13 000 Canadians undergo an ostomy procedure, which requires stoma site marking to create a well-constructed stoma and prevent stoma-related complications. The Canadian Society of Colon and Rectal Surgeons (CSCRS) and Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) created a position statement to provide evidence-based guidance and techniques for stoma site selection. Methods: A task force was formed comprising 20 health care professionals (7 colorectal surgeons from the CSCRS and 13 nurses from NSWOCC) with representation from across Canada. A literature review was performed, with the following databases searched from January 2009 to April 2019: MEDLINE, Embase, Cochrane, PubMed, CINAHL and Google Scholar. After the abstracts were screened, 6 task force members created a draft version of the position statement from the articles retained after full-text review. The draft was submitted to the entire task force for comments, and the ensuing modifications were incorporated. Peer reviewers were then recruited from the CSCRS and NSWOCC; a summary of their comments was reviewed by the task force, and modifications were incorporated to produce the final document. Results: The literature search identified 272 papers, of which 58 were reviewed after duplicates were excluded. After full-text review, 18 papers were included to guide the position statement. From these papers, we created a series of 17 steps for stoma site marking. Four general principles were found to be important for stoma site marking: obtain informed consent, identify important patient factors and landmarks, assess the abdomen and mark the most appropriate location. A 1-page enabler document and video were created as teaching aids and to help with dissemination of the information. Conclusion: This position statement, associated enabler document and video provide evidence-based guidance for stoma site marking in both emergency and elective settings, and should be used by surgeons and nurses specialized in wound, ostomy and continence to identify optimal stoma sites preoperatively.

Ileostomy: Early and Late Complications

“…The future stoma must visible and reachable by the patient for an effortless management so we must include BMI in our decision. 10 20…”

“…10 Occasionally, peristomal skin breakdown and irritation can be a consequence of an inappropriate position of the stoma. 6,20 In fact, other complications such as leakage and poor visualization of the stoma may arise due to an inadequate position of the ileostomy. Hence, marking the stoma site before the surgery has been proven to diminish stomarelated complications.…”

“…This strategy should be performed by a certified ostomy nurse, an enterostomal therapist or a surgeon during an extra patient visit before surgery. 10 Zwiep et al 20 developed a 17-step protocol on preoperative site marking: the patient is invited to a consultation in which the ostomy nurse or the surgeon will preview the abdomen in standing, sitting and dorsal decubitus positions; then, the marking site will be placed between the beltline and the waistline, on the center of the imaginary diagonal line that unites the iliac crest and the umbilicus. It goes without saying that striving for a flat area and avoiding any skin scars, creases, hernias, and bony prominences is highly recommendable.…”

“…The future stoma must visible and reachable by the patient for an effortless management so we must include BMI in our decision. 10,20 Peristomal Pyoderma Gangrenosum Pyoderma gangrenosum was first described as a skin ulceration. Nowadays, it is considered a neutrophilic dermatosis that causes severe pain and skin ulceration.…”

Skin complications in patients with an intestinal stoma

“…Zasady wyboru i oznaczenia miejsca przyszłej stomii są szczegółowo opisywane w zaleceniach i wytycz-nych [27,33,34]. Czynności te są również przedmiotem kształcenia przed-i podyplomowego pielęgniarek (studia magisterskie i kursy specjalistyczne) [35].…”