Collaborative Management of High Output Ileostomy in the Acute Care Setting

Purpose: To present a method of managing a very high output ileostomy, highlighting the collaboration needed from the multidisciplinary team.

Background: Care of the ostomy patient presents many challenges for the multidisciplinary healthcare team. This patient population requires collaboration between physicians, nursing staff, dietary, physical and occupational therapy, and wound, ostomy nursing service. Patients with ostomies can experience complications such as malnutrition, dehydration, electrolyte imbalances, and skin breakdown which decreases quality of life, causes pain, and places the patient at risk for social isolation.

Project Description: This case study aims to present the management of a very high output ileostomy in the acute and critical care setting. We will discuss the contributing factors that lead to the complexity of ostomy management, the interventions that were attempted both successful and unsuccessful from the interdisciplinary healthcare team, and the detailing the successful interventions and ongoing support needed to manage the stoma effluent and protect the patient’s skin.

Results: Pouching system and drainage management system was developed that enabled that patient to have 3-4 days of consistent wear time, peristomal skin remains intact, stoma effluent continues to be contained. Ongoing supplementation needed for hydration and nutrition as ostomy continues to be very high output. And ongoing coaching needed from Wound Care RNs to staff and patient to ensure that drainage tubing is patent, and that gas and effluent build up in pouch is avoided to prevent pouch leakage.

Conclusions: Successful management of stoma effluent and gas can be achieved by collaboration from multidisciplinary healthcare team, and often multiple trials of pouching systems and interventions from a medical and dietary standpoint is needed to support a patient with a very high output ileostomy.