Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Ensure they are aware that any mark made on their body is for guidance purposes only.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C). To familiarize the patient with the procedure. E
2. 2.Show
   Draw curtains around the patient or close the door to ensure privacy.
   To avoid unnecessary embarrassment and to promote dignified care (NMC [178], C).
3. 3.Show
   Wash hands thoroughly using soap and water or an alcohol‐based handrub.
   To prevent the spread of infection by contaminated hands (NHS England and NHSI [161], C).

Procedure

1. 4.Show
   Ensure the patient is in a supine position with one pillow under their head. Ask the patient to lift their clothing to expose the abdomen.
   In order to locate the rectus muscle and observe the characteristics and contours of the abdomen. E
2. 5.Show
   Locate the rectus muscle. The muscle can be identified by asking the patient to raise their head. The muscle may also be palpated and easily felt when the patient coughs.
   Placing the stoma in the rectus muscle reduces the risk of peristomal herniation and prolapse (Leyk et al. [130], E).
3. 6.Show
   Identify a flat area of skin on the abdomen, as this facilitates safe adhesion of the appliance. Avoid siting on bony prominences, skinfolds, the waistline or belt areas.
   Avoiding skin creases, especially in the region of the groin or umbilicus, will help to prevent urine or faecal matter tracking along the skin creases, causing leaks. This also helps the patient to visualize the stoma more easily. Restrictive clothing, such as belts, over the site may lead to unnecessary pressure and leaks or trauma to the stoma. E
4. 7.Show
   Imagine a line running from the umbilicus to the top of the pelvic bone on the appropriate side. Place a piece of tape on the midpoint of this line or at the closest point to it on a flat piece of skin. Mark the tape with an ‘X’.
   This initial marking is used to assess the suitability of the site when the patient is sitting, walking, bending and moving (Leyk et al. [130], E).
5. 8.Show
   Allow the patient to sit up and move around as much as possible to reassess the positioning. Encourage the patient to carry out movements or activities that are associated with their occupation or hobbies. Ensure the patient can see the site.
   This will help to determine the most appropriate site for the patient. E
6. 9.Show
   Secure an appliance to the temporary site and encourage the patient to spend some time wearing the appliance. Where possible, ensure the position allows the patient to view the stoma site and appliance sufficiently.
   Correct positioning will enable self‐care of the stoma and post‐operative rehabilitation (Leyk et al. [130], E).
7. 10.Show
   Once both the nurse and the patient are satisfied with the site, use a permanent marker pen to indicate the site. Cover this mark with a film dressing.
   To ensure the stoma site remains clearly marked until the time of surgery (Leyk et al. [130], E).

Post‐procedure

1. 11.Show
   Wash hands thoroughly using soap and water or an alcohol‐based handrub.
   To prevent the spread of infection by contaminated hands (NHS England and NHSI [161], C).
2. 12.Show
   Document your actions and report them to the appropriate members of the multidisciplinary team.
   To ensure continuity of care and maintain accurate records (NMC [178], C).