A colostomy appliance, often called a colostomy bag, is a medical device that collects waste from a surgically created opening in the abdomen called a stoma. This pouching system is composed of two primary parts: a pouch to collect output and a skin barrier, or wafer, that adheres to the body. Regularly changing this appliance is necessary for maintaining the health of the peristomal skin, the area immediately surrounding the stoma, and for preventing leaks that can cause discomfort or skin breakdown. A routine change helps ensure a secure seal and protects the abdominal skin from the corrosive nature of fecal output.
Essential Preparation and Supplies
Preparation minimizes the time the stoma is uncovered and ensures a sanitary appliance change. Before starting, gather all necessary supplies and set up a private, clean workspace, preferably in a bathroom for easier disposal. Begin by performing thorough hand hygiene using soap and water, as this prevents the introduction of bacteria to the sensitive peristomal area.
The supplies needed include the new pouch and skin barrier system, which may be a one-piece unit or a two-piece system. Other necessary items are a stoma measuring guide, curved scissors for customizing the barrier opening, and a disposal bag. Additionally, keep specialized accessories such as barrier rings or paste, stoma powder, and adhesive remover wipes or spray on hand. These accessories protect the skin and enhance the seal of the new appliance.
Step-by-Step Removal and Cleaning
The removal process must be executed gently to avoid skin stripping, which is the mechanical trauma of peeling away the top layer of skin cells. Start by slowly peeling the used skin barrier away from the skin, working from the top down while simultaneously holding the surrounding skin taut with the other hand. An adhesive remover (wipe or spray) can be applied to the barrier’s edge as you peel to dissolve the bond and ease removal, significantly reducing the risk of trauma.
Once the old appliance is removed, immediately seal it in the disposal bag to contain odor and mess. The stoma and surrounding peristomal skin should then be cleaned gently using warm water and a soft, disposable wipe or cloth. Do not use harsh solvents, disinfectant wipes, or soaps that contain oils or residues, as these can interfere with the new barrier’s ability to adhere to the skin. The stoma may bleed slightly when cleaned, which is normal since it is rich in blood vessels, but the bleeding should stop quickly.
After cleaning, the skin must be completely dry before applying any new products, as moisture will prevent proper adhesion of the new wafer. Thoroughly pat the peristomal skin dry, ensuring no residual moisture remains, which can foster fungal growth or compromise the seal. Inspect the skin for any signs of irritation, such as redness, rash, or broken areas, before applying the new system. If the skin is weepy or moist from irritation, a light dusting of stoma powder can be applied to absorb the moisture, followed by a skin barrier film to seal the powder and create a protective surface for the new appliance.
Securing the New Ostomy Appliance
A secure fit of the new ostomy appliance is important to prevent output from contacting the skin, which is the primary cause of peristomal skin irritation. The first step involves accurately measuring the stoma’s diameter using the provided measuring guide, since stoma size can change over time. The opening in the new skin barrier must be cut to fit the stoma closely, leaving only about one-eighth of an inch of exposed skin around the stoma.
If the skin barrier is not pre-cut, use curved scissors to precisely cut the opening on the back of the wafer, tracing the measurement onto the backing paper first. The opening should be smooth and match the stoma’s shape, without any jagged edges that could irritate the skin. For cut-to-fit systems, pull the pouch material away from the wafer while cutting to avoid accidentally snipping the pouch.
Once the wafer is cut, apply any necessary accessory products to the skin or the wafer to create a uniform surface for adhesion. Barrier rings or moldable seals fill in skin folds, creases, or dips around the stoma, creating a flat plane and preventing effluent from tunneling underneath the adhesive. Barrier paste can also be used to fill small gaps, but should not be applied directly to open or broken skin.
To prepare the new wafer, peel the protective backing off the adhesive surface without touching the sticky part. Center the wafer carefully over the stoma, ensuring the opening aligns precisely, and apply it to the skin from the bottom up. Gently press the adhesive firmly against the skin, smoothing out any wrinkles that could allow leakage pathways. Finally, hold the palm of your hand over the newly applied wafer for one to two minutes; this warmth activates the hydrocolloid adhesive, promoting a stronger and more secure bond to the skin.
Maintaining the Pouch and Recognizing Issues
Proper maintenance of the appliance after it is secured helps maximize wear time and prevents unnecessary changes. Drainable pouches should be emptied into the toilet when they are approximately one-third to one-half full. Allowing the pouch to become too full places excessive weight and tension on the skin barrier, which can compromise the seal and lead to premature leakage.
If using a closed-end system, the pouch is typically removed and replaced with a new one after each bowel movement or when it reaches capacity. Beyond routine emptying, be aware of signs that the appliance needs to be changed sooner than scheduled. Persistent itching, a burning sensation, or pain around the stoma are all indicators of potential skin irritation, often caused by a small leak.
Other signs of a problem include visible skin breakdown, a rash, or the adhesive beginning to lift or erode around the edges. Any of these symptoms suggest that the barrier is no longer providing a complete seal and must be replaced immediately to prevent further damage to the peristomal skin.