Changing an Ostomy Appliance

Changing an Ostomy Appliance

Equipment
■ Skin care items per agency protocol (e.g., pH-balanced skin cleanser, skin prep, skin barrier wipe, adhesive remover, adhesive paste, and stoma paste if needed).
■ Stoma measuring guide (or precut template).
■ Scissors.
■ Pen or pencil.
■ 2 pairs of procedure gloves.
■ Wash cloth, towel, basin with warm water.
■ Toilet tissue.
■ 4 in. 4 in. gauze pad.
■ Bedpan or container for effluent.
■ Plastic bag for disposal of used pouch.
■ Plastic bag for disposal of other contaminated articles.
■ Waterproof pad.
■ Ostomy deodorant.
■ Hypoallergenic paper tape (optional) or ostomy belt.
■ Bath blanket.
■ Ostomy pouch:
■ One-piece pouch with the wafer attached, or a two-piece system with a separate wafer and pouch.
■ Clamp for pouches with an opening at the bottom (you do not need a new clamp each time).

Assessment
■ Determine the changing schedule for the pouch and whether a new clamp is needed.
■ Observe abdominal shape and incision, if present. Auscultate for bowel sounds.
■ Assess the type of stoma (e.g., ileostomy, colostomy, urostomy), number of stomas, and location on the abdomen to determine the type of pouch to use.
■ Assess stoma color, shape, size, and/or length of protrusion or retraction; stoma construction (end, loop, double barrel); direction of stoma lumen; and discharge.
■ Be Smart! The stoma should be moist and red or pink. Alterations in color (purple, black, or blue) may indicate poor circulation and necrosis and should be reported to the primary provider.
■ Assess peristomal skin for redness, rash, irritation, or excoriation. Observe the existing skin barrier and pouch for leakage and length of time in place. You may have to remove the pouch to observe the stoma fully.
■ Be Smart! Notify the primary care provider or an ostomy specialist immediately if you note peristomal skin abnormalities.
■ Measure the stoma with each pouching system. Follow the manufacturer’s directions and measuring guide for the size of ostomy pouch and the patient’s stoma size.

Post-Procedure Reassessment
■ Observe:
■ Characteristics of stoma: color, size, presence of edema, and shape.
■ Presence of blisters, redness, or excoriation on peristomal skin.
■ Amount and characteristics of effluent: color, odor, consistency.
■ Whether the patient expressed a desire to participate in the task or demonstrated nonverbal cues that she is ready to learn about the task (e.g., looking at the stoma).
■ The patient’s condition and self-care ability (consider vision, dexterity or mobility, and cognitive ability).

Key Points
■ Be Smart! Change the pouch every 3 to 5 days, as a general rule.
■ Empty the old pouch before removing it, if possible.
■ Remove the wafer or pouch, pulling down from the top with one hand while holding countertension with the other.
■ Assess the stoma and the peristomal skin area (e.g., for discoloration, swelling, redness, irritation, excoriation, bleeding).
■ Use a measuring guide to determine the size of the stoma.
■ Trace the size of the opening onto the back of the wafer, and cut the wafer opening about 2 to 3 mm (1/16 to 1/8 in.) larger.
■ Apply the new wafer with gentle pressure.
■ Some pouches come with the wafer attached, some without. These instructions assume that the wafer is attached.

Documentation
■ Document:
■ Your assessment of the stoma and peristomal skin area.
■ Patient’s tolerance of the procedure.
■ Type of appliance used, including the manufacturer and part number.
■ Use of any special ostomy skin care products.
■ Amount of liquid effluent (on the I&O portion of the graphics record).
■ Patient teaching and the degree to which the patient participated in the procedure.

Apply adhesive remover with one hand as you press the skin away from

the wafer with the other hand