Ostomy Nursing

Preoperative planning for the potential need for a stoma is critical in improving patients’ postoperative quality of life, reducing postoperative complications, and promoting their independence. This planning includes both preoperative counseling and stoma marking by an ostomy nurse (Figure 1). Often, it is helpful for the patient to speak with other willing patients who have been in similar situations and under similar care; support group participation may be valuable.[1]

Figure 1. Stoma Marking by an Ostomy Nurse

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Colostomy, ileostomy, and/or urostomy sites should be properly marked by an enterostomal therapist or ostomy nurse. Sites should be chosen to avoid scars, skin creases, and other skin disorders. Stoma marking should be done with the patient in the lying, sitting, and standing positions with attention to the belt line and pant height. The site must be checked to ensure that skin folds or crevices do not interfere with the appliance fitting. In patients with obesity, the stoma usually is placed in the upper abdomen, so it will not be hidden below a large abdominal pannus (Figure 2). Stomas should be typically placed through the rectus sheath to minimize the risk of parastomal hernias.[2]

Figure 2. Stoma Placed in Upper Abdomen of Patient With Obesity

Reprinted with permission, Cleveland Clinic Foundation ©2025. All Rights Reserved.