Changing an ostomy pouch, or stoma bag, is a routine procedure for individuals managing an ostomy, a surgically created opening on the abdomen. This process involves the careful removal of the used appliance and the precise application of a new one, ensuring hygiene and a secure seal. The ostomy appliance consists of an adhesive skin barrier (or wafer) and a pouch, designed to protect the skin and manage waste output. Mastering this technique is important for preventing skin irritation and maintaining consistent wear time.
Gathering Supplies and Setting the Stage
Before starting the change, gather all necessary items to ensure a smooth process. Essential supplies include a new ostomy pouching system, specialized adhesive remover wipes or spray, a sizing guide, scissors, mild soap, warm water, and a disposal bag. You may also need a clean towel, stoma paste, barrier rings, or protective powder.
The best time to perform a change is when the stoma is least active, typically first thing in the morning or just before going to bed. Choose a clean, private, and well-lit environment, such as a bathroom, to maintain hygiene and visibility. Lay out the supplies on a clean surface, and thoroughly wash your hands before touching the appliance.
Safe Removal of the Existing Pouch
First, empty any contents from the existing pouch into the toilet if it is a drainable system to minimize mess. The adhesive barrier must be removed gently and slowly to protect the delicate peristomal skin. Rapid removal can cause skin stripping, where the top layer of skin is pulled away with the adhesive, leading to irritation and pain.
To remove the pouch safely, use one hand to support and press down on the skin adjacent to the appliance’s edge. With the other hand, peel the adhesive barrier back from the skin, starting from the top and working downward. If the adhesive is strong or removal is painful, apply a specialized, sting-free adhesive remover spray or wipe to the barrier’s edge as you peel it back. Once removed, immediately place the soiled pouch into a sealable disposal bag.
Cleansing and Skin Assessment
After the old appliance is removed, the stoma and the surrounding peristomal skin must be meticulously cleaned. Use warm water and a soft cloth or specialized wipe to gently remove any residual output or adhesive. If using soap, select one that is mild and free of oils, perfumes, and moisturizing lotions, as these residues compromise the adhesion of the new barrier.
The cleaning motion should be a gentle wiping or patting action, avoiding harsh rubbing that could irritate the skin. Minor spots of blood are not unusual during cleaning, as the stoma contains many small blood vessels. After cleaning, the skin must be patted completely dry, as the new adhesive barrier will not adhere securely to moist skin.
This is the time to visually inspect the stoma and the peristomal skin for any changes or signs of irritation. A healthy stoma should appear moist and pink or red. The surrounding skin should look the same as the skin elsewhere on the abdomen, without significant redness, rash, or breakdown. If the skin is irritated or has moist, broken areas, stoma powder can be lightly dusted onto the affected area and patted to remove any excess before applying the new barrier.
Securing the New Appliance
Securing the new pouching system begins with preparing the skin barrier, especially if a cut-to-fit system is being used. Use a specialized measuring guide to determine the stoma’s current size and shape. Aim for an opening that allows a small gap of approximately 1.5 to 3 millimeters of skin to be visible around the stoma. This precise sizing prevents output from contacting the skin and avoids friction against the stoma itself.
Transfer the measurement onto the backing of the new barrier and use curved scissors to cut the opening accurately. Before application, a skin barrier film or specialized paste can be applied to the peristomal area to create a protective layer or fill in uneven skin contours. Allow any protective products to dry completely for optimal adhesion.
To promote a strong bond, warm the adhesive on the new barrier before application to activate the hydrocolloid material. This can be done by rubbing the barrier between the palms or using a low-setting hairdryer for a few seconds. Remove the backing paper and carefully center the appliance over the stoma, smoothing upward to remove any wrinkles or air pockets. Apply firm, gentle pressure with your palm over the entire barrier for 30 to 45 seconds; the warmth aids in conforming the adhesive to the body’s contours and securing the seal.