Stoma site marking

Question 1

Criteria for correct stoma site marking and appropriate strategies for selecting the appropriate stoma site (e.g.. maneuvers for identifying the rectus muscle)

Answer 1

Flat pouching surface
Identify rectus muscle, mark borders
symphysis pubis
pt laugh, cough, sneeze

Question 2

Recommended procedure for marking the site (use of indelible marker)

Answer 2

“Pouch site recommendation”- ø surgical site selection
Sharpie pen (dry and repeat)
Give pen to pt to reinforce
Transparent drsg (may come off during remove in OR, inform OR staff)
Tatoos: inject 0.1 cc sterile methylene blue
Scratches (25G needle) - not recommended, portal of entry for infection/bacteria; painful.

Question 3

Priorities in stoma site selection (given a hypothetical patient situation)

Answer 3

1. Flat pouching surface
2. within Rectus muscle
3. within Patient’s visual field
4. Away from belt line, bony prominences and umbilicus (2-3 inches clearance)

Obese (mesentery pulled, 5-7cm), pannus folds, large breast, w/c bound, continent diversions, adhesions, radiation t