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Self-Irrigation Instructions for Patients with an Indiana Pouch

This card tells you how to irrigate your Indiana pouch. Irrigation is done to prevent mucus from clogging your catheter tubes and from building up on the lining of the pouch. Your nurse will review the steps with you. The card also has general guidelines to follow after you go home. Please speak to your doctor or nurse if you have any questions.

Self-Irrigation Instructions:

Irrigate 3 times each day unless your doctor has given you other instructions.

Supplies

  • One 60 mL (cc) syringe
  • Normal saline
  • A small container

Instructions

  1. Wash your hands.
  2. Open the bottle of saline.
  3. Remove the plunger from the outside of the syringe. Lie down at a 30- to 45-degree angle.
  4. Disconnect your stoma tube from its drainage bag (see figure). 
  5. Attach the outside of the syringe to the stoma tube. Pour in 60 mL (cc) of saline. Raise the stoma tube straight up to promote good drainage.
  6. After the saline drains into your pouch, watch to see if it then drains into the cecostomy tube drainage bag. Most likely, mucus will drain also. If drainage through the cecostomy tube occurs promptly, repeat this step once. This is called gravity irrigation. If you are successful with gravity irrigation, you are finished and can go to step 12. Otherwise continue the steps below.
  7. If the saline does not flow out of the cecostomy tube, reconnect the drainage bag to the stoma tube and try gravity irrigation through the cecostomy tube. Watch for the saline to flow out of the stoma tube. Repeat this step once. If you are able to irrigate through your cecostomy tube, you are finished and can go to step 12. Otherwise, follow steps 8 through 12.
  8. If gravity irrigation doesn't work through the cecostomy tube, empty the saline from the syringe casing into a small container and discard it. Then disconnect the casing from the tube and reconnect your drainage bag. Put the plunger back into the casing.
  9. Pull 30-50 mL (cc) of saline into the syringe. If necessary, put the syringe down on a clean surface. Disconnect the drainage bag from either tube. Place the syringe into the tube. Very gently push the saline into the tube. This is called flushing. Don't force the saline. If you meet resistance, try the other tube.
  10. Pull back gently on the syringe. This is called aspiration. If you pull back a large amount of mucus, repeat steps 9 and 10 on the same tube until the drainage appears clear. If you meet resistance to aspiration, do not use force. Remove the syringe and reconnect the tube to the drainage bag. Get up and walk around; you will probably see drainage in the bag at this point.
  11. Return to step 5 and try gravity irrigation again. You should see better results this time.
  12. Wash your hands.

Please note: You can use the same syringe again. Clean the syringe after each use by pulling the plunger out of the casing and washing both with warm water and soap. Let them air dry on a clean surface.

Discharge Guidelines:

  • Keep the tubes connected to the leg bag during the day. You will need to empty these bags about every 2 hours. At night, connect the tubes to the larger drainage bags. This will allow you to sleep through the night without emptying your bags.
  • Keep the tubings connected to your body or leg with tape or Cath-Secures®.
  • Drink eight, 8-ounce glasses of non-caffeinated liquids per day.
  • Do not drink any alcohol until your tubes have been removed.
  • Exercise daily. Walk several times a day (as tolerated) for one-half hour each time.
  • Shower daily. Let warm water run gently over the tubes. Pat dry; do not rub.
  • Wipe any mucus from the stoma with a damp, clean washcloth or a 4” x 4” gauze pad.
  • Do not cover the tube areas with a dressing unless there is drainage.

Call Your Doctor or Nurse If You:

  • Can't flush or get any return from either your stoma or cecostomy tube.
  • Have no urine draining at all. (If urine is draining from only one bag, that is O.K.)
  • Feel pressure, pain, bloating, or swelling in your abdomen.
    • Try to irrigate first to relieve any mucus plug that could be causing these symptoms.
  • Develop a fever over 101° F (38.3° C).
  • Notice your incision is red, hot, or leaking pus.
  • Notice foul-smelling urine.
  • Develop nausea with vomiting.