mikeyarmo
Co-Founder
- Joined
- Feb 13, 2006
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Recnetly I have been in contact with an individual named Terry Gallagher. He had an ileostomy formed after he had developed a gangrenous colon. He provided me with some information that he was willing to share, so feel free to take a look at it. This will probably be some good information that would help for the community project (if you do not know what that is see the thread in the announcement forum).
Ileostomy Formation
Prior to surgery, you'll be attending, I expect, a pre-admissions clinic where you'll be examined by a doctor who'll take a medical history, sound your chest, listen to your heart and check your blood pressure. You may sign your consent form at this time. You'll probably have to bring a urine sample which will be tested for diabetes by a nurse and someone will take bloods. These will be cross matched as you'll need a blood transfusion during the surgery - this is entirely routine and nothing unusual. Your blood will also be tested for several other things, U & E and so on. This is just to check you're fit enough for the surgery. You'll have a twelve lead ecg (electrocardiogram) and you may have a chest X-ray, although, when I was 52, I was been considered too young to need this!
On admission, after all the questionnaires and wrist bands, you'll be given one of these; Picolax, KleanPrep, Fleet Phospho-soda or Citramag. All of these are designed to empty you out, literally. You'll spend rather a long time in the toilet once they start to work. Citramag is usually a single dose, Fleet and Picolax are given as two doses several hours apart and KleanPrep is four litres to be drunk at the rate of 250 ml every quarter of an hour. On a personal note, the nurses are well used to people having bowel prep complaining of being sore because of having the 'runs' because of these very powerful laxatives (KleanPrep works rather differently - it isn't absorbed and literally just washes everything through you). They will provide a soothing cream on request (often zinc and castor oil cream). Picolax, as far as I'm concerned is the worst for causing a sore 'tail end' and needing some cream.
You may be given neomycin which is an antibiotic which sterilises the bowel - I've never had it, though. The night before your surgery, it may be a good idea to have already asked for a sleeping pill for that night to prevent your lying awake worrying - that's human and natural. On the day of surgery, you will be asked to have a shower, possibly using antibacterial soap to kill germs on your skin and then change into your theatre gown - the one with the open back and ties with most of the ties missing if it's a typical NHS gown! You will also be measured for and wear white anti-embolus stockings: these help to prevent blood clots and you may have twice daily injections of heparin to help to prevent clots as well. You may be lucky and get the once daily tinziparin which is more expensive, but does the same job. The anaesthetist will have seen you to discuss your anaesthetic and premed if he/she feels you need it. Pain control is usually by epidural as this prevents shock during the surgery as the body, even though anaesthetised, feels pain so the epidural stops that. Most of them work brilliantly - I'm just unfortunate! If the anaesthetist isn't a fan of epidurals (and most of them are these days) tell him about morphine. There are alternatives - I'm all right with pethidine for example. the stoma nurse should visit you and mark your stoma site for the surgeon. Two to three centimetres down from a line through the navel and half way between navel and the side of your body is about right, avoiding any awkward creases and below your belt line. You do not want your stoma at or above your waist.
These days you probably won't be shaved before the surgery - I wasn't shaved at all for mine. When the trolley comes to take you down to theatre, you'll have wrist bands checked and your name asked again and again - it's to make sure that the right operation is done on the right person. You'll be taken usually into a holding area and then into the anaesthetic room where you'll be checked again. You'll have a three lead ecg taped onto your chest, a blood pressure cuff around one arm and a pulse oximeter on a finger, usually not of the hand on the arm with the blood pressure cuff. The last measures your pulse rate and the amount of oxygen in your blood. Some anaesthetists insert the epidural while you're awake - others 'knock you out' first. If you have the epidural while you're awake, you'll sit on the trolley, bent forward, with a nurse in front of you to support you and your feet up on a stool. It sounds worse than it is, believe me. The thought of it was worse than having it done (and, yes, I've had it done both ways - awake and asleep). You'll have a cannula (Venflon) put into a vein in the back of your hand or lower arm. This tube is inserted into a vein and is taped down. After flushing it with saline to check it's working properly, the anaesthetist will inject a cocktail of drugs to put you to sleep. Once you're asleep, he'll put a tube down your throat through your vocal cords (you may have a slightly sore throat on waking because of this) and inflate a cuff around it to seal it in place. This is called an ETT - endotracheal tube. You'll be paralysed, so you'll be connected to a respirator though this tube. Your intestines 'wriggle' (it's called peristalsis) and so the surgeon needs to have this stopped or he couldn't operate. Again, this is normal. You'll probably have a central line put in to a large vein either in your neck or the upper part of your chest (I've had both) so that fluids can be administered easily. You may have a tube inserted into an artery in your wrist to monitor arterial blood pressure.
During surgery, your useless colon will be removed and the end of the terminal ileum (the small intestine where it joins the caecum near the appendix to become the large intestine) will be brought out through as hole made on the right hand side of the abdomen. The ileum will be turned back on itself like the cuff of a pullover, or trouser turn-ups and this is stitched to the surface of the abdomen to make the stoma. Make sure you ask for a decent spout on your ileostomy (2 to 3 cm - you don't want a short or flush stoma as it will be very difficult to care for). It is worth writing “Stoma spout to protrude between 2 to 3 cm when the post operative swelling has gone down” on your consent form. Whilst you're anaesthetised, you should have a naso-gastric tube inserted up your nose and into your stomach to drain off stomach fluids until your digestive system starts working again, several days later.
You will either wake up in recovery or in ITU or HDU. I've been in both the intensive care unit (reversal of my colostomy) and in the high dependency unit (urostomy) as well as nursed in an open ward when I had my ileostomy - the last because I didn't have an epidural, but was on pethidine PCA (Patient controlled analgesia - push the button every five minutes for another dose of pain killer). If you are in either HDU or ITU, the normal sort of stay for this type of surgery is 24 to 48 hours. You will have a clear ileostomy pouch over your new stoma which will be swollen from the bruising caused by the surgical procedure. It takes a few weeks to settle down and will be smaller by the time it's not bruised any more. that is why you'll need to re-measure your stoma every week for the first few weeks. Your stoma nurse should show you how to do this. There will be a 2 litre drainage bag attached to your pouch and you will use one of these at night to save getting up to empty your pouch. (more on this later) You will have either a latex or PVC drain connected to another 2 litre bag. This will be bloody - don't worry, it's supposed to be and will clear up when it will be removed once your abdominal cavity has stopped draining. It is stitched in and is not exactly comfortable to have removed. Take a deep breath as they pull it out - it helps. You will be on oxygen at first, again usual after any general anaesthetic. You may still be having a blood transfusion, but, more likely, will be on crystalloid infusions. These are saline, glucose and potassium chloride to keep you hydrated until you are able to be on free fluids and to make up your electrolyte levels in your blood. You will be monitored regularly, with the frequency decreasing as your condition improves and stabilises. The frequency of this is down to the practice of your hospital. In HDU, every quarter of an hour, then hourly, four hourly six hourly and finally twice daily is not uncommon. Your wound will be from just above your pubic bone to above your navel probably and will be closed with clips: these are so simple to have removed and are much better than stitches. They look horrible (NHS zip!) but remove oh so easily with the special clip removers. This normally happens after ten days. The naso-gastric tube will have a collection bag pinned to your gown and the tube will probably be aspirated (sucked using a large syringe) to keep your stomach empty.
Ileostomy Formation
Prior to surgery, you'll be attending, I expect, a pre-admissions clinic where you'll be examined by a doctor who'll take a medical history, sound your chest, listen to your heart and check your blood pressure. You may sign your consent form at this time. You'll probably have to bring a urine sample which will be tested for diabetes by a nurse and someone will take bloods. These will be cross matched as you'll need a blood transfusion during the surgery - this is entirely routine and nothing unusual. Your blood will also be tested for several other things, U & E and so on. This is just to check you're fit enough for the surgery. You'll have a twelve lead ecg (electrocardiogram) and you may have a chest X-ray, although, when I was 52, I was been considered too young to need this!
On admission, after all the questionnaires and wrist bands, you'll be given one of these; Picolax, KleanPrep, Fleet Phospho-soda or Citramag. All of these are designed to empty you out, literally. You'll spend rather a long time in the toilet once they start to work. Citramag is usually a single dose, Fleet and Picolax are given as two doses several hours apart and KleanPrep is four litres to be drunk at the rate of 250 ml every quarter of an hour. On a personal note, the nurses are well used to people having bowel prep complaining of being sore because of having the 'runs' because of these very powerful laxatives (KleanPrep works rather differently - it isn't absorbed and literally just washes everything through you). They will provide a soothing cream on request (often zinc and castor oil cream). Picolax, as far as I'm concerned is the worst for causing a sore 'tail end' and needing some cream.
You may be given neomycin which is an antibiotic which sterilises the bowel - I've never had it, though. The night before your surgery, it may be a good idea to have already asked for a sleeping pill for that night to prevent your lying awake worrying - that's human and natural. On the day of surgery, you will be asked to have a shower, possibly using antibacterial soap to kill germs on your skin and then change into your theatre gown - the one with the open back and ties with most of the ties missing if it's a typical NHS gown! You will also be measured for and wear white anti-embolus stockings: these help to prevent blood clots and you may have twice daily injections of heparin to help to prevent clots as well. You may be lucky and get the once daily tinziparin which is more expensive, but does the same job. The anaesthetist will have seen you to discuss your anaesthetic and premed if he/she feels you need it. Pain control is usually by epidural as this prevents shock during the surgery as the body, even though anaesthetised, feels pain so the epidural stops that. Most of them work brilliantly - I'm just unfortunate! If the anaesthetist isn't a fan of epidurals (and most of them are these days) tell him about morphine. There are alternatives - I'm all right with pethidine for example. the stoma nurse should visit you and mark your stoma site for the surgeon. Two to three centimetres down from a line through the navel and half way between navel and the side of your body is about right, avoiding any awkward creases and below your belt line. You do not want your stoma at or above your waist.
These days you probably won't be shaved before the surgery - I wasn't shaved at all for mine. When the trolley comes to take you down to theatre, you'll have wrist bands checked and your name asked again and again - it's to make sure that the right operation is done on the right person. You'll be taken usually into a holding area and then into the anaesthetic room where you'll be checked again. You'll have a three lead ecg taped onto your chest, a blood pressure cuff around one arm and a pulse oximeter on a finger, usually not of the hand on the arm with the blood pressure cuff. The last measures your pulse rate and the amount of oxygen in your blood. Some anaesthetists insert the epidural while you're awake - others 'knock you out' first. If you have the epidural while you're awake, you'll sit on the trolley, bent forward, with a nurse in front of you to support you and your feet up on a stool. It sounds worse than it is, believe me. The thought of it was worse than having it done (and, yes, I've had it done both ways - awake and asleep). You'll have a cannula (Venflon) put into a vein in the back of your hand or lower arm. This tube is inserted into a vein and is taped down. After flushing it with saline to check it's working properly, the anaesthetist will inject a cocktail of drugs to put you to sleep. Once you're asleep, he'll put a tube down your throat through your vocal cords (you may have a slightly sore throat on waking because of this) and inflate a cuff around it to seal it in place. This is called an ETT - endotracheal tube. You'll be paralysed, so you'll be connected to a respirator though this tube. Your intestines 'wriggle' (it's called peristalsis) and so the surgeon needs to have this stopped or he couldn't operate. Again, this is normal. You'll probably have a central line put in to a large vein either in your neck or the upper part of your chest (I've had both) so that fluids can be administered easily. You may have a tube inserted into an artery in your wrist to monitor arterial blood pressure.
During surgery, your useless colon will be removed and the end of the terminal ileum (the small intestine where it joins the caecum near the appendix to become the large intestine) will be brought out through as hole made on the right hand side of the abdomen. The ileum will be turned back on itself like the cuff of a pullover, or trouser turn-ups and this is stitched to the surface of the abdomen to make the stoma. Make sure you ask for a decent spout on your ileostomy (2 to 3 cm - you don't want a short or flush stoma as it will be very difficult to care for). It is worth writing “Stoma spout to protrude between 2 to 3 cm when the post operative swelling has gone down” on your consent form. Whilst you're anaesthetised, you should have a naso-gastric tube inserted up your nose and into your stomach to drain off stomach fluids until your digestive system starts working again, several days later.
You will either wake up in recovery or in ITU or HDU. I've been in both the intensive care unit (reversal of my colostomy) and in the high dependency unit (urostomy) as well as nursed in an open ward when I had my ileostomy - the last because I didn't have an epidural, but was on pethidine PCA (Patient controlled analgesia - push the button every five minutes for another dose of pain killer). If you are in either HDU or ITU, the normal sort of stay for this type of surgery is 24 to 48 hours. You will have a clear ileostomy pouch over your new stoma which will be swollen from the bruising caused by the surgical procedure. It takes a few weeks to settle down and will be smaller by the time it's not bruised any more. that is why you'll need to re-measure your stoma every week for the first few weeks. Your stoma nurse should show you how to do this. There will be a 2 litre drainage bag attached to your pouch and you will use one of these at night to save getting up to empty your pouch. (more on this later) You will have either a latex or PVC drain connected to another 2 litre bag. This will be bloody - don't worry, it's supposed to be and will clear up when it will be removed once your abdominal cavity has stopped draining. It is stitched in and is not exactly comfortable to have removed. Take a deep breath as they pull it out - it helps. You will be on oxygen at first, again usual after any general anaesthetic. You may still be having a blood transfusion, but, more likely, will be on crystalloid infusions. These are saline, glucose and potassium chloride to keep you hydrated until you are able to be on free fluids and to make up your electrolyte levels in your blood. You will be monitored regularly, with the frequency decreasing as your condition improves and stabilises. The frequency of this is down to the practice of your hospital. In HDU, every quarter of an hour, then hourly, four hourly six hourly and finally twice daily is not uncommon. Your wound will be from just above your pubic bone to above your navel probably and will be closed with clips: these are so simple to have removed and are much better than stitches. They look horrible (NHS zip!) but remove oh so easily with the special clip removers. This normally happens after ten days. The naso-gastric tube will have a collection bag pinned to your gown and the tube will probably be aspirated (sucked using a large syringe) to keep your stomach empty.
