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Stoma Site Selection
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Guidelines for Stoma Site Selection

M. Elizabeth Foster, RN, MS, CPN, CWOCN

Stoma site selection is part of the preoperative preparation for a child undergoing anticipated ostomy surgery. A well constructed, well-placed stoma will be easier for the patient, family, and nurse to manage, and will decrease the risk of skin and stoma complications. Preoperative site selection is generally omitted for infants and/or emergency procedures, but is strongly recommended for long-term or permanent stomas.


DO:
  • Use indelible ink marker for stoma site
  • Have the child wear their usual underwear, clothing, and belt styles, as well as any prosthetic device that fits near the abdomen
  • Position the child sitting, standing, and lying before permanently marking the site; note wrinkles and abdominal contours in each position, and adjust the site location accordingly
  • Leave about 4cm of smooth skin around site
  • Mark the site below the waistline (lower abdominal quadrants) and/or clothing line except in the following special circumstances: gross obesity, wheelchair bound, severe scoliosis, ascites, physical disability that limits access, dexterity, or vision
  • Mark urinary stomas and fecal stomas on different horizontal planes (A non-pouched vesicostomy should be below a fecal stoma. A pouched urinary diversion may be above or below a fecal diversion but above is preferable if the patient will be wearing an ostomy belt)
  • Mark sites on both the right and left sides of the abdomen in case surgical outcomes are different than planned
  • Mark site over abdominal muscle

DO NOT:
  • Mark the site intraoperatively
  • Mark a site in the waistline or where any article of clothing will rest on the stoma
  • Mark a site near the umbilicus, groin, waistline, costal margin, in a skin fold, near a bony prominence, in or around a past or future radiation site, or near old scars or incisions
ACCEPTABLE ALTERNATIVES:
  • Upper abdominal quadrants work well when the patient is obese, wheelchair bound, or has ascites (easier for the patient to see and access the stoma)
  • The umbilicus is acceptable for continent diversion stomas (ACE or appendicovesicostomy)
  • Lumbar sites have been used for patients with unacceptable abdominal contours or severe scoliosis
  • A site may be marked by cleansing the area with alcohol, allow to dry, then scratch a small "x" on the site with a 25 guage needle

References:
Smith, DB. Stoma site selection. J Enterostomal Ther. 1982;9(6):60-62.
Corman, ML.. Preoperative considerations. In: MacKeigan, JM & Cataldo, PA, eds.
Intestinal Stomas: Principles, Techniques, and Management. St. Louis: Quality Medical Publishing, Inc; chap 3.
Hampton, B. & Bryant, RA, eds. Ostomies and Continent Diversions: Nursing Management. St. Louis: Mosby -Year Book; 1992.