From the Guidelines
Self-catheterization for patients with an ileostomy should be performed using clean non-coated catheterization as the most cost-effective method, with attention to preventing infection and maintaining both urinary and stoma function. Patients should wash hands thoroughly with soap and water before beginning, and gather all supplies including a clean catheter (typically 14-16 French size), water-based lubricant, antiseptic wipes, and a collection container 1. The catheterization procedure remains similar to standard technique: clean the urethral opening with antiseptic wipes moving from front to back, lubricate the catheter tip, insert it gently until urine flows, and remove it slowly once flow stops. For ileostomy patients specifically, it's essential to empty the ostomy bag before catheterization to prevent leakage during the procedure, position yourself comfortably to avoid strain on the stoma site, and keep the stoma covered during catheterization to maintain cleanliness.
Some key considerations for patients with an ileostomy include:
- Emptying the ostomy bag before catheterization
- Positioning comfortably to avoid strain on the stoma site
- Keeping the stoma covered during catheterization
- Using separate clean towels and supplies for stoma care and catheterization to prevent cross-contamination
- Monitoring for signs of urinary tract infection, including cloudy urine, burning sensation, fever, or unusual odor
- Maintaining a balanced diet and fluid intake to prevent dehydration, as recommended by the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1.
It's also important to note that the type of intermittent catheter used has little effect on the rate of symptomatic infection, but a significant impact on cost 1. Therefore, clean non-coated catheterization is recommended as the most cost-effective method, with gel reservoir catheters as an alternative option if clean non-coated catheterization is not viable. Patients should be educated on the importance of monitoring fluid balance and preventing dehydration, and an ileostomy pathway based on patient education can help reduce readmission rates for dehydration 1.
From the Research
Guidelines for Self-Catheterization in Patients with an Ileostomy
- There are no specific guidelines provided in the given studies for self-catheterization in patients with an ileostomy 2, 3, 4, 5, 6.
- However, study 3 discusses the experience with non-sterile intermittent self-catheterization, which may be relevant to patients with ileostomies who require catheterization.
- Study 5 reviews the management of neurogenic bladder dysfunction with incontinent ileovesicostomy, which involves the creation of an ileovesicostomy to manage urinary dysfunction, but does not specifically address self-catheterization in patients with an ileostomy.
- Study 6 introduces a new type of ostomy, transcecum catheterization ileostomy (TCI), which is designed to prevent anastomotic leakage after laparoscopic rectal cancer surgery, but does not provide guidelines for self-catheterization.
Complications and Management
- Patients with ileostomies are prone to peristomal skin problems, fluid and electrolyte imbalances, and nutritional imbalances 2.
- Study 4 investigates the effect of loperamide on ileostomy output and finds that it can reduce output, but with varying effects among patients.
- Study 5 reports complications observed in patients who underwent incontinent ileovesicostomy, including urinary tract infections and ureteral stones.
Surgical Interventions
- Study 6 compares the safety and efficacy of transcecum catheterization ileostomy (TCI) with preventive ileostomy (PI) and finds that TCI is effective in preventing anastomotic leakage and reducing the rate of anastomotic stricture.
- Study 5 reviews the operative results and complications of incontinent ileovesicostomy in patients with neurogenic bladder dysfunction.