Emptying and Changing a Stoma Appliance on an Ileal Conduit

Goal: The stoma appliance is applied correctly to the skin to allow urine 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 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. If the patient is in bed, adjust the bed to a comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Place waterproof pad under the patient at the stoma site.

Emptying the Appliance:
6. Put on gloves. Hold end of appliance over a bedpan, toilet, or measuring device. Remove the end cap from the spout. Open spout and empty contents into the bedpan, toilet, or measuring device.

7. Close the spout. Wipe the spout with toilet tissue. Replace the cap.

8. Remove equipment. Remove gloves. Assist patient to comfortable position.

9. If appliance is not to be changed, place bed in lowest position. Remove additional PPE, if used. Perform hand hygiene.

Changing the Appliance:
10. Place a disposable waterproof pad on the overbed table or other work area. Set up the washbasin with warm water and the rest of the supplies. Place a trash bag within reach.

11. Put on clean gloves. Place waterproof pad under the patient at the stoma site. Empty the appliance if necessary as described in steps 6–8.

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

13. 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.

14. Clean skin around stoma with mild soap and water or a cleansing agent and a washcloth. Remove all old adhesive from skin; additional adhesive remover may be used. Do not apply lotion to peristomal area.

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

16. Place one or two gauze squares over stoma opening.

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. Check that the spout is closed and the end cap is in place.

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

20. Secure optional belt to appliance and around patient.

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 any remaining equipment and assess patient’s response to procedure.

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