In ileostomy lavage, what is the first procedural step?

• A. Manipulate with gloved, lubricated finger to palpate blockage
• B. Insert 14-16 FR catheter
• C. Warm bath or heating pad
• D. IVF

Answer: (A)

The question tests what to do first when managing a suspected ileostomy blockage during lavage. The initial action is to palpate the stoma with a gloved, lubricated finger to assess for a blockage. This tactile check quickly reveals whether stool is backed up and where the obstruction lies, and it helps you judge whether the tissue is viable and if there might be contributing factors like twisting or edema. Getting this assessment right before any instrumentation ensures you don’t risk tissue trauma or unnecessary instrumentation, and it guides the next steps—such as whether to proceed with catheter irrigation or reconsider the approach.

Inserting a catheter is the next procedural step if irrigation is indicated, but it should follow the initial palpation so you’re informed about the obstruction. Warming measures or a heating pad aren’t primary steps in initiating lavage, and intravenous fluids are supportive and not part of the first lavage action.