Obtain |
1 | Stoma site selection and marking must be undertaken only by qualified practitioners within their scope of practice who possess the knowledge, skill and judgment to perform stoma site marking — a surgeon or NSWOC is recommended. |
2 | Invite the patient to a private area to explain the process. |
3 | Provide patient education and counselling on living with an ostomy stoma. |
4 | Obtain patient verbal consent for the assessment and stoma site marking. |
5 | Learn from the patient their typical range of movements related to their mobility, occupation, lifestyle and cultural practices. |
Assess |
6 | Ask the patient to remove enough clothes to allow access to the abdomen while maintaining privacy. |
7 | Assess the abdomen to observe scars, skin folds, hernias, skin mounds, creases, wrinkles, bony protuberances/iliac crest, radiation sites, pendulous breasts and the location of the umbilicus in order to avoid these areas during marking. |
8 | Ask the patient to lie on their back and have the patient raise their head to see their feet to identify the edge of the rectus abdominis muscle. |
Identify |
9 | Identify the patient’s usual beltline and waistline in normal clothing in sitting and standing positions in order to avoid these lines during marking. |
10 | Identify the halfway point on the imaginary diagonal line between bony protuberances/iliac crest and the umbilicus. |
11 | Ask the patient to sit, stand, bend, twist and lie down to identify any creases or concerns with the proposed site. |
12 | Consider the patient’s body mass index/body habitus and eyesight to confirm that the suggested stoma site is within their visual field, if possible. |
Mark |
13 | Mark the abdomen with a regular pen on the flattest possible place in the appropriate quadrant for the planned surgery within the borders of the rectus abdominis muscle, 5 cm away from the considerations identified in steps 7, 9 and 11. |
14 | In complex cases, seek a second opinion from another NSWOC or surgeon, which may involve sharing a photograph, with the patient’s consent. |
15 | Remark with a permanent skin marker on the patient’s abdomen the site agreed on by the patient and the NSWOC. |
16 | Cover the mark with a transparent film dressing. Explain to the patient the importance of maintaining the mark and give supplies to reinforce marking, if required. Remove all other marks with alcohol swab. |
17 | Document the details in the patient’s health record. |