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🛏️ Basic Care & Comfort · Lesson 6 of 6 · 6 min

Catheters, Ostomies and the Stoma Color Chart

🟣 A healthy stoma is the color of the inside of your cheek. A purple one is dying. A pale one can signal anemia. The exam shows you a color and asks whether to chart it or call.

💡 Key idea

Catheter bag below the bladder, closed system, out as soon as possible. Stoma pink and moist is healthy; dusky or purple is an emergency; empty the pouch at one-third full.

🧠 Why it matters

INDWELLING URINARY CATHETERS: insert with sterile technique only when truly indicated and remove as soon as possible to prevent CAUTI; keep the bag BELOW bladder level and off the floor, keep the tubing free of kinks and dependent loops, secure the catheter to the thigh, perform routine perineal care, maintain a closed system, and empty the bag at least every 8 hours. Do not disconnect for samples; use the sampling port. After removal, monitor for voiding within 6 to 8 hours. OSTOMY care: a healthy STOMA is pink to red, moist and slightly raised; dusky, purple or black indicates ischemia and is reported immediately; pale suggests anemia. Expect ileostomy output to be liquid and frequent, with high fluid and electrolyte losses, while sigmoid colostomy output is formed. Empty the pouch when it is one-third to one-half full, cut the wafer about 1/8 inch (3 mm) larger than the stoma to protect the skin, and teach that mild swelling in the first weeks is normal. Foods that cause gas or odor (beans, cabbage, onions, eggs) can be limited; yogurt and parsley may reduce odor.

🏥 In the real world

🧴 On the first post-op day a new ileostomy stoma looks swollen and bright red; the client is alarmed. The nurse explains that edema and a beefy red color are expected early. Two hours later the stoma turns a deep purple at the edge. Now the nurse calls the surgeon: compromised blood supply is a surgical emergency, and the difference between the two calls is nothing but color.

📌 Takeaways

  • Catheter: below bladder, closed system, secured, removed early
  • Stoma: pink or red and moist is normal; dusky, purple or black means ischemia
  • Ileostomy output is liquid; watch fluids and electrolytes

📖 Terms in this lesson

Stoma: The surgically created opening of an ostomy, healthy when pink and moist and an emergency when dusky or purple.

CAUTI: A catheter-associated urinary tract infection, prevented by sterile insertion, a closed system and early removal.

✅ Test yourself

Which action by unlicensed assistive personnel caring for a client with an indwelling catheter requires correction?
  1. Securing the catheter tubing to the thigh
  2. Hanging the drainage bag on the bed rail above the mattress level during transport
  3. Keeping the drainage bag below the level of the bladder
  4. Emptying the bag every 8 hours

Answer: B · Hanging the drainage bag on the bed rail above the mattress level during transport

A bag above the bladder allows urine to flow back into the bladder, increasing infection risk. It must stay below bladder level.

The nurse assesses a new colostomy stoma that is dark purple. What is the priority action?
  1. Document the finding as expected
  2. Apply a warm compress
  3. Notify the surgeon immediately
  4. Change the pouch system

Answer: C · Notify the surgeon immediately

A dusky or purple stoma indicates compromised circulation and possible necrosis, which requires immediate surgical evaluation.

A client with a new ileostomy asks when to empty the pouch. What is the correct teaching?
  1. When it is completely full
  2. Once a day at bedtime
  3. Only when it leaks
  4. When it is one-third to one-half full

Answer: D · When it is one-third to one-half full

Emptying at one-third to one-half full prevents the weight from breaking the seal and causing leaks.

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