A two-piece colostomy appliance is a modular system designed to manage intestinal output following a colostomy procedure. This system consists of two distinct parts: a skin barrier, often called a flange or wafer, that adheres to the body, and a separate, detachable collection pouch. The skin barrier is designed to remain in place for multiple days, providing a secure and protective seal around the stoma. This separation allows the pouch to be changed or emptied without disturbing the skin barrier’s seal on the skin. By minimizing the frequency of adhesive removal from the delicate peristomal area, the two-piece design helps reduce the risk of skin trauma and irritation.
Essential Supplies and Preparation
Before beginning the change process, gathering all necessary items ensures a smooth and hygienic routine. Supplies should include a new two-piece skin barrier and pouch, a measuring guide, specialized ostomy scissors, and a disposal bag. You will also need warm water, a soft cloth or paper towels for cleaning, and optional accessories like adhesive remover wipes, a skin barrier ring or paste, and protective gloves. Establish a clean, private workspace, ideally in the bathroom where a toilet is accessible for disposal.
The new skin barrier requires preparation before the old system is removed to minimize the time the stoma is uncovered. Use the measuring guide to determine the stoma’s current size. Trace this size onto the protective backing of the new skin barrier and carefully cut the opening using specialized scissors. The opening should be approximately two to three millimeters larger than the stoma to allow for slight movement without exposing the surrounding skin to output.
Step-by-Step Removal and Skin Assessment
The first step in removal is to empty the existing pouch into the toilet. The old skin barrier must be peeled off gently, moving slowly from the top edge downward to protect the skin. To minimize skin stripping, use one hand to hold the skin taut while the other peels the adhesive barrier away. Adhesive remover wipes or spray can be used to dissolve the bond between the adhesive and the skin, aiding in gentle removal.
After removal, the peristomal skin (the area surrounding the stoma) must be cleaned thoroughly. Use warm water and a soft, non-soapy cloth to gently wipe away any remaining stool or adhesive residue. Avoid using harsh soaps, baby wipes, or alcohol-based cleansers, as these can interfere with the new barrier’s adhesion or cause irritation. Pat the skin completely dry, as the new adhesive will not form a secure seal on a moist surface.
Assessment of the stoma and surrounding skin should be performed at every change. The stoma itself should appear moist, beefy red, or pink, similar to the tissue lining the inside of the mouth. Any significant change in color, such as a dusky or dark appearance, requires immediate professional attention, as it can indicate compromised blood flow. Inspect the peristomal skin for any signs of redness, open areas, rashes, or erosion.
Minor irritation or weepy skin can be treated by dusting the affected area with a specialized ostomy skin barrier powder. This powder absorbs excess moisture and provides a dry surface for the adhesive to stick to, creating a protective crust. If the irritation covers a large area or includes deep erosion, contact a healthcare professional or ostomy nurse for guidance. Observing the underside of the removed skin barrier for signs of leakage, such as dark staining or erosion of the adhesive, is important. This observation helps identify if the previous seal was compromised and informs necessary adjustments to the next application.
Attaching the New Pouch System
The application process begins with the new, pre-cut skin barrier. If the peristomal skin has dips, scars, or an uneven surface, a barrier ring or paste can be used to fill these contours. A barrier ring can be stretched and molded to fit snugly around the stoma, creating a level plane for the wafer to adhere to. This accessory is applied directly to the skin or placed onto the adhesive side of the wafer before application.
Before peeling the backing off the wafer, gently stretch the skin around the stoma taut to minimize wrinkles. Peel the protective backing and carefully center the opening over the stoma, ensuring a close fit. Apply the barrier to the skin, starting from the area immediately surrounding the stoma and moving outward to the edges. Any wrinkles or creases in the adhesive layer must be smoothed out immediately, as they can compromise the seal.
Once the barrier is in place, apply gentle but firm pressure with the palm of the hand for up to a minute. The warmth from the hand helps activate the adhesive properties of the wafer, improving the initial bond and ensuring a secure seal. The final step is to attach the new collection pouch to the flange of the skin barrier. The two pieces are aligned and pressed together, resulting in an audible click or snap that confirms a secure mechanical connection.
The position of the pouch should be considered after it is attached to the wafer, as it can be rotated before the mechanical lock is fully engaged. The pouch is typically positioned vertically for daytime use, allowing gravity to assist drainage. It may be rotated to a horizontal position when lying down or if a specific activity requires it. This flexibility allows the user to adjust the system to their body and activity level without removing the skin barrier.
Troubleshooting Common Issues
Leakage is a frequent challenge, often resulting from an improperly sized barrier opening. If the opening is too large, output seeps onto the skin, undermining the adhesive seal and causing irritation. If leaks occur frequently, the stoma should be remeasured, as its size and shape can change over time. Another common cause of leaks is an overfull pouch; the pouch should be emptied when it is about one-third full, as weight pulls against the skin barrier.
“Pancaking” occurs when thick colostomy output sticks to the top of the pouch, potentially blocking the stoma. This can be managed by coating the inside of the pouch with a specialized lubricating deodorant or drops, allowing the output to slide to the bottom. Introducing a small amount of air into the pouch before sealing it also helps prevent the front and back walls from sticking together. Odor is controlled by modern pouches that incorporate carbon filters, but limiting gas-producing foods may also be necessary.
Severe skin breakdown, persistent pain, or a change in the stoma’s appearance indicate that professional consultation is needed. If the stoma turns a dark or dusky color, or if there is excessive, unexplained bleeding, seek immediate medical attention. Ongoing leaks that cannot be resolved with sizing adjustments or barrier rings also warrant an appointment with an ostomy nurse. The nurse can evaluate the fit and recommend a different product type, such as a convex barrier, if necessary.