A colostomy is a surgical procedure that creates an opening, known as a stoma, on the abdomen to divert a portion of the colon to the body’s exterior, allowing stool to exit into a collection pouching system. Since the stoma lacks a muscular sphincter, the passage of waste is not voluntary, making a well-managed external system crucial for health and comfort. The primary goal of colostomy care is to maintain the integrity of the peristomal skin, which is the skin immediately surrounding the stoma, and prevent irritating complications. This requires a precise and gentle technique for changing the pouching system to avoid contact between the effluent and the sensitive abdominal skin.
Preparation and Supply Gathering
Before beginning the procedure, gathering all necessary supplies and establishing a clean, private environment is important to prevent infection and skin damage. The optimal time for a pouch change is when the stoma is least active, often first thing in the morning before eating or approximately one to three hours after a meal. You will need the new pouching system, which includes the wafer or skin barrier, along with:
- A measuring guide
- A pen
- Scissors
- A soft cloth or gauze
- Warm water
- Non-sterile gloves
- A disposable bag for the old system
- Skin barrier paste or ring, and an adhesive remover wipe
After performing hand hygiene, donning non-sterile gloves helps maintain asepsis and protects the caregiver from contact with the effluent. The patient’s privacy should be secured, and a protective waterproof pad can be placed beneath the existing pouch to manage any unexpected output during the change. This careful preparation minimizes interruptions and the potential for a hurried, less precise application of the new system. Securing a comfortable position, such as sitting on a toilet or lying in bed with the abdomen exposed, aids in a smooth transition between appliances.
Step-by-Step Procedure for Pouch Replacement
The initial step involves gently removing the existing pouching system by peeling the skin barrier downward while simultaneously using the opposite hand to press the adjacent skin away from the adhesive. This technique minimizes trauma and stripping of the delicate peristomal skin, which can lead to irritation. If the adhesive is firm, a specialized adhesive remover wipe can be used to dissolve the bond as the wafer is peeled back, protecting the skin. Once removed, the used system should be immediately placed into a disposable bag, and any contents should be emptied into the toilet before disposal.
The exposed stoma and surrounding skin must be cleaned using only warm tap water and a soft cloth or gauze, avoiding harsh soaps, which can leave a residue that interferes with the new adhesive seal. Gentle wiping motions are sufficient to remove any residual stool or mucus; scrubbing the skin must be avoided. The skin must be completely pat-dried afterward, as a damp surface prevents the new wafer from forming a secure, lasting seal. A dry surface is necessary for optimal adhesion, sometimes requiring the use of a hair dryer on a cool setting.
With the skin clean and dry, the stoma must be measured using a stoma measuring guide, as its size and shape can fluctuate. The new wafer is then prepared by tracing the measured shape onto the backing paper and cutting the opening. Ensure the diameter is no more than two to three millimeters (1/8th inch) larger than the stoma itself. This minimal clearance protects the peristomal skin from corrosive effluent. If the skin surface is uneven due to scars or folds, a barrier ring or paste should be applied to flatten the surface and create a smooth plane for the wafer.
The new skin barrier is applied by removing the protective backing and aligning the cut hole directly over the stoma. The wafer should be pressed firmly onto the skin, working outward from the stoma to the edges, ensuring a wrinkle-free application. Since many skin barrier adhesives are heat-sensitive, holding the hand over the newly applied wafer for about 60 seconds uses body heat to enhance the initial bond. A secure seal prevents leakage and protects the skin, completing the procedure.
Assessing the Stoma and Surrounding Skin
Immediately following the pouch change, a thorough assessment of the stoma and the surrounding peristomal skin is necessary. A healthy, viable stoma should appear moist and a deep pink or beefy red color. The stoma is highly vascular, meaning it is normal to observe slight bleeding when it is gently cleaned or rubbed, a finding that should not cause alarm. Because the stoma lacks sensory nerve endings, the patient will not feel pain from the stoma itself, making visual inspection the primary method of monitoring its health.
Any color change, such as the stoma turning pale, dusky blue, or black, signals compromised blood flow and requires immediate medical attention. The peristomal skin should look like the skin on the rest of the abdomen and must be examined for signs of irritation, known as peristomal dermatitis. Indicators of a problem include:
- Persistent redness
- Itching
- A burning sensation
- Skin breakdown with weeping or open areas
These skin issues are caused by a poor-fitting pouch, which allows the intestinal output to contact and erode the skin. If a patient experiences recurrent leakage, persistent pain, or a rash that does not resolve within a day or two, they should contact a healthcare provider or a Wound, Ostomy, and Continence (WOC) nurse. An ostomy nurse can re-evaluate the stoma size and shape and recommend a different pouching system or accessory products to re-establish a healthy seal and protect the skin.