Changing a pouching system/ostomy appliance (ileostomy or colostomy)
- Pouching system should be changed every 4 to 7 days, as advised by the doctor.
- Consult a wound care specialist or equivalent if the skin around the stoma is discolored, inflamed or indurated or if the pouch leaks, or if there are other concerns related to the pouching system.
- Patients family involvement is key to a healthy ostomy
- Encourage patient to empty the pouch when it is one-quarter to one-half full of urine, gas, or feces.
- Follow doctors and dietician’s orders on medications and diet
- An ostomy belt may be used to help hold the ostomy pouch in place.
- Sweating, high heat, moist or oily skin can lead to an unhealthy stoma .
- Always treat minor skin irritations right away. Skin that is sore, wet, or red is difficult to seal with a flange for a proper leakproof fit.
| Steps | Information |
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| 1. Perform hand hygiene |
This prevents the spread of microorganisms.
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| 2. Keep supplies ready |
Flange (skin barrier), ostomy bag and clip, scissors, stoma measuring guide, adhesive remover for skin, skin prep, stomahesive paste or powder, wet cloth, non-sterile gloves, and additional napkin.
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| 3. Teach the patient to perform the cleaning procedure by themselves | This will help patients to keep stoma healthy |
| 4. Advice patient to use water proof sheet on the bed | This prevents the spilling of contents of bag on patient and bedsheets. |
| 5. Wear gloves. When bag is removed for emptying, measure content. Discard used pouching system in garbage bag. |
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| 6. Support skin and remove skin barrier by gently pulling it toward the stoma. An adhesive remover may be used. |
An adhesive remover may be used to decrease skin damage and hair stripping.
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| 7. Clean stoma gently by wiping with warm water. Do not use soap or alcohol based rub |
Aggressive cleaning can cause bleeding.
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| 8. Assess stoma and peristomal skin. |
A stoma should be pink to red in colour, raised above skin level, and moist.
Skin surrounding the stoma should be intact and free from wounds, rashes, or discoloration. |
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9. Measure the stoma diameter and cut out stoma hole. Trace diameter of the measuring guide onto the flange, and cut on the outside of the pen marking. |
The opening should be 2 mm larger than the stoma size. Keep the measurement guide with patient supplies for future use. Once size is traced onto back of flange, cut out size to fit stoma
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10.Prepare skin and apply accessory products |
Accessory products may include stomahesive paste, stomahesive powder, or products used to create a skin sealant to adhere pouching system to skin to prevent leaking. Wet skin will prevent the flange from adhering to the skin
Peristomal skin prep |
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11. Remove inner backing on flange and apply flange over stoma. Leave the border tape on. Apply pressure. Hold in place for 1 minute to warm the flange to meld to patient’s body. Then remove outer border backing and press gently to create seal. |
The warmth of the hand can help the appliance adhere to the skin and prevent leakage. |
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12. Apply the ostomy bag. Attach the clip to the bottom of the bag. |
This step prevents the effluent from soiling the patient or bed. Apply ostomy pouch
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13. Hold palm of the hand over ostomy pouch for 2 minutes to assist with appliance adhering to skin. |
The flange is heat activated. |
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14. Clean up supplies, and place patient in a comfortable position. Remove garbage from patient’s room. |
Removing garbage helps decrease odour. |
