Changing and Emptying an Ostomy Appliance

Goal: The stoma appliance is applied correctly to the skin to allow stool to drain freely.

1. Bring necessary equipment to the bedside stand or overbed table.

2. Perform hand hygiene and put on PPE, if indicated.

3. Identify the patient.

4. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient. Encourage the patient to observe or participate, if possible.

5. Assist patient to a comfortable sitting or lying position in bed or a standing or sitting position in the bathroom.

Emptying an Appliance
6. Put on disposable gloves. Remove clamp and fold end of pouch upward like a cuff.

7. Empty contents into bedpan, toilet, or measuring device.

8. Wipe the lower 2 inches of the appliance or pouch with toilet tissue.

9. Uncuff edge of appliance or pouch and apply clip or clamp, or secure Velcro closure. Ensure the curve of the clamp follows the curve of the patient’s body. Remove
gloves. Assist patient to a comfortable position.

10. If appliance is not to be changed, remove additional PPE, if used. Perform hand hygiene.

Changing an Appliance
11. Place a disposable pad on the work surface. Set up the wash basin with warm water and the rest of the supplies. Place a trash bag within reach.

12. Put on clean gloves. Place waterproof pad under the patient at the stoma site. Empty the appliance as described previously.

13. Gently remove pouch faceplate from skin by pushing skin from appliance rather than pulling appliance from skin. Start at the top of the appliance, while keeping the abdominal skin taut. Apply a silicone-based adhesive remover by spraying or wiping with the remover wipe.

14. Place the appliance in the trash bag, if disposable. If reusable, set aside to wash in lukewarm soap and water and allow to air dry after the new appliance is in place.

15. Use toilet tissue to remove any excess stool from stoma. Cover stoma with gauze pad. Clean skin around stoma with mild soap and water or a cleansing agent and a washcloth. Remove all old adhesive from skin; use an adhesive remover, as necessary. Do not apply lotion to peristomal area.

16. Gently pat area dry. Make sure skin around stoma is thoroughly dry. Assess stoma and condition of surrounding skin.

17. Apply skin protectant to a 2-inch (5 cm) radius around the stoma, and allow it to dry completely, which takes about 30 seconds.

18. Lift the gauze squares for a moment and measure the stoma opening, using the measurement guide. Replace the gauze. Trace the same-size opening on the back center of the appliance. Cut the opening 1/8 inch larger than the stoma size.

19. Remove the backing from the appliance. Quickly remove the gauze squares and ease the appliance over the stoma. Gently press onto the skin while smoothing over the
surface. Apply gentle pressure to appliance for 5 minutes.

20. Close bottom of appliance or pouch by folding the end upward and using the clamp or clip that comes with the product, or secure Velcro closure. Ensure the curve of the clamp follows the curve of the patient’s body.

21. Remove gloves. Assist the patient to a comfortable position. Cover the patient with bed linens. Place the bed in the lowest position.

22. Put on clean gloves. Remove or discard equipment and assess patient’s response to procedure.

23. Remove gloves and additional PPE, if used. Perform hand hygiene.