The device used after a colostomy procedure to collect waste is correctly termed an ostomy pouch or colostomy system. A colostomy creates an opening called a stoma from the colon to the abdomen. Mastering the proper technique for changing this system is important for maintaining comfort, preventing leaks, and protecting the skin surrounding the stoma. This process ensures effective hygiene and promotes the long-term health of the peristomal skin, the area directly beneath the adhesive barrier.
Essential Supplies and Preparation
Before starting the change, gather all necessary supplies and prepare the workspace to ensure a smooth, uninterrupted process. Required items include the new ostomy pouching system (one-piece or two-piece) and a stoma measuring guide. You will also need specialized ostomy scissors for precision cutting of the barrier. Skin preparation items are necessary, such as specialized skin barrier paste or rings, stoma powder for irritated skin, and adhesive remover wipes or spray. Finally, you should have warm water, soft non-woven wipes or paper towels for cleaning and drying, and a disposal bag for the used appliance.
Once all supplies are within arm’s reach, wash your hands thoroughly with soap and water to minimize the risk of introducing bacteria. Changing the system when the stoma is less active, such as first thing in the morning before eating, can help manage output during the process. Finding a comfortable, private location, preferably near a toilet, allows you to relax and focus on the task of skin and stoma care.
Step-by-Step Removal of the Used Pouch
The removal of the used appliance must be done gently and slowly to avoid stripping the top layer of skin, which is a common cause of irritation. If the appliance is drainable, the contents should first be emptied into the toilet before proceeding. Begin by peeling back the adhesive barrier from the top edge, working downward toward the stoma.
As you peel the barrier with one hand, use the other hand to gently press down on the adjacent skin, employing the “push-pull” technique. This opposing pressure helps detach the adhesive from the skin rather than pulling the skin away from the body. If the adhesive is particularly secure, using an adhesive remover wipe or spray can help dissolve the bond for a gentler release. Once the system is fully removed, immediately place the soiled appliance into a disposal bag and seal it to contain odor and maintain hygiene.
Caring for the Skin and Stoma
After the used appliance is removed, the peristomal skin must be thoroughly cleaned and inspected. The stoma itself does not have nerve endings, but the surrounding skin is sensitive and requires careful treatment. Use warm water and soft, non-woven wipes to gently clean the area, removing any residual stool or adhesive.
Avoid using soaps that contain oils, perfumes, or lotions, as these residues can interfere with the adherence of the new barrier and compromise the seal. After cleaning, the skin must be patted completely dry, since the adhesive will not bond effectively to moist skin. Assess the health of the stoma, which should be moist and pink or red, indicating a healthy blood supply. The surrounding skin should look similar to the rest of the abdomen, showing no signs of significant redness, rash, or breakdown.
If the peristomal skin shows signs of wetness or irritation, dust a specialized stoma powder onto the affected area and lightly brush off the excess so only a thin layer remains. A skin barrier wipe or spray can then be applied over the powder to create a seal and provide a protective layer. Before applying the new system, measure the stoma using the provided guide, as the size and shape can change over time. The opening in the new barrier should be cut to fit snugly around the stoma, ideally leaving a clearance of only about one-eighth of an inch (2–3 millimeters) to protect the skin from output.
Securely Applying the New Ostomy System
The first step in applying the new system involves preparing the wafer or skin barrier based on the recent measurements. For a cut-to-fit system, the traced outline is cut precisely, and any rough edges are smoothed out with a finger to prevent irritation. If required, apply a moldable ring or thin bead of barrier paste to the back of the wafer, positioned closest to the stoma opening. This helps fill in any skin creases or uneven contours to create a tight seal.
Next, remove the protective backing from the adhesive side of the barrier, being careful not to touch the exposed adhesive surface. Many adhesives benefit from being slightly warmed before application, which can be achieved by rubbing the wafer gently between your hands. This warmth enhances the tackiness and pliability of the adhesive, improving the initial bond to the skin.
Position the barrier carefully, centering the opening directly over the stoma, using a mirror if necessary for accuracy. Once the barrier is in place, press down gently but firmly, starting from the area immediately surrounding the stoma and working outward toward the edges of the wafer. Maintain steady, gentle pressure over the entire surface for 30 to 60 seconds. This sustained contact is necessary to fully activate the adhesive and ensure a secure, wrinkle-free seal. If using a two-piece system, the new pouch is then clicked or flanged onto the barrier plate, ensuring the connection is locked to prevent accidental detachment.