This Patient has a Continent Intestinal Reservoir (CIR) Continent Ileostomy
Symptoms: No output when a #30 Fr catheter is inserted into internal pouch, cramping abdominal discomfort with abdominal distention, nausea and vomiting, absent or faint bowel sounds.
1. Emergency Room Nurse: Contact the patient’s CIR surgeon or local surgeon and obtain order for treatment.
Ernest Rehnke M.D., F.A.C.S.
Susan Kay R.N.
2. Administer pain medication as indicated.
3. Begin IV fluids (Lactated Ringer’s/Normal Saline)
4. Obtain abdominal X-rays to determine the site/cause of the obstruction.
5. Insert a #30 Fr catheter into the internal pouch via the small stoma located in the lower abdomen. TAPE THE CATHETER to the skin at insertion site. IF USING A FOLEY CATHETER, DO NOT INFLATE THE BULB. (Inflation of the bulb can place pressure on the tip of the valve causing sloughing of the valve.) Cut the bulb balloon at the catheter tip prior to insertion to prevent someone else from inflating the bulb.
6. Connect the catheter to low intermittent suction.
7. Irrigate the catheter using 30-60cc of Normal Saline every 2 hours (irrigation saline).
8. Insert naso-gastric tube into the stomach and connect to low intermittent suction.
9. Laboratory studies/test to evaluate fluid and electrolyte balance.
10. Make patient NPO (Nothing by mouth.)