Changing a pouching system/ostomy appliance (ileostomy or colostomy)

Safety considerations: 
  • 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
1. Perform hand hygiene

This prevents the spread of microorganisms.

Hand hygiene with alcohol based hand rubs

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.

Ostomy supplies

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. 

Remove ostomy bag from flange/ skin barrier

 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.

Remove barrier

7. Clean stoma gently by wiping with warm water. Do not use soap or alcohol based rub

Aggressive cleaning can cause bleeding.

Clean stoma and peristomal skin

8. Assess stoma and peristomal skin.

 A stoma should be pink to red in colour, raised above skin level, and moist.

Assess stoma

Skin surrounding the stoma should be intact and free from wounds, rashes, or discoloration.

 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


Assess flange for proper fit to stoma

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                       

Stomahesive paste

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.

 Remove backing from flange

 Apply flange around stoma

 Press gently to create seal

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

 Attach clip to bottom of bag


13. Hold palm of the hand over ostomy pouch for 2 minutes to assist with appliance adhering to skin.

The flange is heat activated.

14. Clean up supplies, and place patient in a comfortable position. Remove garbage from patient’s room.

Removing garbage helps decrease odour.

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