Early Colostomy Formation Can Improve Independence Following Spinal Cord Injury and Increase Acceptability of Bowel Management.

Background: Colostomy formation can solve complications of bowel management following spinal cord injury (SCI). Newly injured patients at this spinal unit have chosen colostomy as a preferred option for bowel management. Objectives: To discover the reasons patients choose colostomy formation early following SCI and make comparison with those choosing it later, and to establish whether early colostomy is safe and advisable. Methods: Medical and nursing records of patients with SCI who chose to have a colostomy during the period 2005-2016 were examined retrospectively. Data were gathered concerning reasons for choosing a colostomy, early and later complications, the need for further surgery, and independence with bowel care before and after surgery. Patients were divided into two groups: those who chose a colostomy "early" during inpatient rehabilitation and those who chose it "later" as is traditional. Results: Reasons for choosing colostomy differed. Reducing reliance on caregiver and independence were of more importance to the early group; the later group chose colostomy to solve bowel care problems. Early complication rates in both groups were low. Longer term complications were higher in the early group, with the most common complication being rectal discharge. Parastomal hernia rates were low in both groups, as was the need for further surgery. Colostomy formation led to 20.8% of all patients gaining independence with bowel care. Conclusion: This study found colostomy to be a safe and effective option when performed early after SCI and demonstrates colostomy can be a means of gaining independence and making bowel care easier and more acceptable to the newly injured patient.

Deficiency or dementia? Exploring B12 deficiency after urostomy.

Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left untreated can lead to irreversible damage to the brain and nervous system. This article discusses the case of a 70-year-old female with a urostomy, well known to the stoma care department, who shortly after a routine parastomal hernia repair developed severe confusion, immobility and was unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a diagnosis of rapidly progressing vascular dementia was made. An incidental finding of a low vitamin B12 level was identified and treatment commenced. She was transferred to a community hospital and her family were told to 'prepare for the worst'. It was, in fact, the vitamin B12 deficiency that was causing her symptoms of vascular dementia, and once treatment was established she underwent a 'miraculous' improvement, returning to normal life. This article discusses vitamin B12 deficiency and why patients with a urostomy are at risk of developing it; highlights the key role of the stoma care nurse and his or her knowledge of the patient; explores the importance of testing vitamin B12 levels in this group of patients; and discusses key learning and recommendations for practice.

The Enhanced Recovery Programme for stoma patients: an audit.

An enhanced recovery programme was implemented at Salisbury NHS Foundation Trust for elective patients undergoing colonic surgery with a stoma in October 2007. The programme is a multimodal approach first described by Professor H. Kehlet in 2000. In order for ERP to be successful in reducing length of stay and promoting earlier stoma independence, there was a need to educate, inform and prepare patients comprehensively in the pre-operative phase to enhance their understanding. A change of practice was necessary as, traditionally, the majority of practical and psychological care was promoted in the post-operative phase. A retrospective audit was carried out on 20 patients before undertaking the enhanced recovery programme, and 20 patients afterwards, which demonstrated a reduction in the patients' mean length of stay from 20 to 7 days, with 60% being discharged at 5 days or less after the programme. The mean number of days until stoma-independent decreased from 12 to 5 days as a result of the enhanced recovery programme. A further 40 patients have been audited.

Case study: negative pressure wound therapy in an abdominal wound.

This article explores the history and management of large abdominal wounds and the importance of a multi-disciplinary team approach to wound healing. It identifies the difficulties of using negative pressure wound therapy (NPWT) in a patient with a large abdominal wound, which is further complicated by an ileostomy. NPWT is increasingly used for large wounds with positive outcomes, however, the case study demonstrates the many difficulties involved and how they were overcome. Cavity wounds can take weeks, or even months to heal and many patients become frustrated. This can have a significant impact on their quality of life. Prolonged hospitalization is not only devastating to the patient and family both physically, psychologically and financially, but is also costly in terms of nursing time and resources.