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Why is a Colostomy Needed for Patients with Severe Bed Sores?
By Nursing Home Law Center
Bed sores are open wounds that progress relatively quickly without appropriate monitoring and treatment. When patients in nursing homes and assisted living facilities develop severe bed sores, attending physicians may need to take appropriate steps to prevent infection and secondary complications.
Colostomy is a common requirement for patients in his condition; this procedure surgically diverts fecal matter into a collection receptacle, preventing it from potentially affected damaged tissues in the lower body and causing infection.
Pressure ulcers almost always develop in the lowest parts of the body in patients who require extensive bed rest or the use of a wheelchair to move around. As these individuals remain stationary, blood collects in the lowest parts of the body, usually around areas with bony protrusions like the hips, back, knees, and feet. When these wounds develop near the abdomen, they can potentially lead to infections and other serious conditions due to exposure to fecal matter.
What is a Colostomy?
"Colostomy" or "diverting colostomy" is a major surgical procedure that involves cutting the patient's colon and attaching it to the wall of the abdomen. The remaining portion of the colon connected to the rectum remains inside the patient's body and becomes dormant, leaving the possibility of reversing the procedure and reattaching the colon in the future. Small plastic bags attach to the opening in the wall of the abdomen for waste collection. Once a bag is full, the patient or an attending caregiver replaces it with a new one.
The idea of undergoing a colostomy procedure can be incredibly disheartening for many nursing home patients; caring for a colostomy patient requires careful attention to bag replacement and cleaning the abdominal opening to prevent infections. Undergoing a colostomy procedure can dramatically impact quality of life, and many nursing home patients require this procedure after a positive diagnosis of pressure ulcers.
How Does a Colostomy Help Pressure Ulcers?
A bed sore or pressure ulcer is an open wound vulnerable to infections. Treatment generally requires keeping the wound clean and bandaged and removing any necrotic tissue at the wound site. A colostomy procedure may be necessary to prevent infections, especially if the patient's bed sore is physically located near any part of the lower digestive system. If the wound grows, it could potentially make contact with and damage the intestinal tract, causing exposure to harmful bacteria in fecal matter and leading to an infection.
Without a colostomy, the chances of a nursing home patient with bed sores developing septicemia or sepsis greatly increase. These are potentially fatal medical conditions, especially for elderly individuals who may suffer from compromised immune systems and other medical conditions like diabetes, malnourishment, or vitamin deficiencies that slow natural healing.
Prevention and Treatment
One of the best ways for nursing homes to limit a patient's risk of requiring colostomy is through prevention of bed sores. Staff should reposition patients at a minimum of every two hours, and more frequently for higher-risk patients.
When older patients undergo hip fracture surgery or other surgical procedures, attending surgical teams should ensure they do not spend too long on the operating table and allow pressure ulcers to develop. Proper nutrition and reasonable, appropriate amounts of daily physical activity also help prevent bed sores.
When nursing home staff positively identifies a pressure ulcer they should take immediate corrective action. Most state laws require nursing homes to observe bed sores at a minimum of once per week and write up detailed reports of their findings. Failure to do so can cause the bed sore to progress very rapidly and increase the chances the patient will require a colostomy.
Colostomies may be disheartening, uncomfortable, and even unwelcome procedures for most nursing home residents, but it is vital for them to remember that this procedure may be necessary to effectively treat some pressure ulcers and prevent potentially fatal infections.
- Use or misuse of colostomy to heal pressure ulcers
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