Preoperative, Intraoperative, and Postoperative Ostomy Care
Preoperative
For elective surgery, the WOC nurse marks the stoma site: within the rectus abdominis, away from the umbilicus, belt line, creases, scars, bony prominences, and planned incision; assess lying, sitting, and standing; confirm the patient can see the mark. Preoperative education covers the procedure, expected stoma, appliances, sexual function and fertility, enhanced recovery, and support resources.
Intraoperative and postoperative
Surgical construction includes end ileostomy or colostomy (Brooke), loop stoma, continent ileostomy, IPAA, and ileal conduit. Postoperatively assess viability-pink/red and moist is normal; dusky, purple, or black suggests ischemia. Edema is expected early. Watch for necrosis, mucocutaneous separation, retraction, stenosis, prolapse, and bleeding. Track output, fluid/electrolyte balance, diet advancement, pain, VTE prophylaxis, and teaching readiness.
Traps: omitting marking in elective cases; confusing expected edema with prolapse; assuming every dusky stoma needs immediate revision (often observe and obtain surgical consultation); failing to quantify output; and teaching too much on postoperative day 1.
Rule of thumb: every elective stoma patient should have a preoperative mark, and the stoma should be within the rectus and visible to the patient.
Worked example: a patient with obesity and a pendulous abdomen is marked while supine only. Reassess sitting and standing; place the mark in the upper abdomen within the rectus on a flat surface, avoiding the infraumbilical fold.