An ileostomy is a surgically created opening, known as a stoma, formed from the end of the small intestine (ileum) and brought out through the abdominal wall. This procedure diverts liquid or semi-liquid digestive waste away from the large intestine and rectum. Since the stoma lacks muscle control, a specialized pouching system is worn to securely collect the waste. Regularly changing this appliance is necessary, and maintaining a secure seal is paramount for skin protection and comfort, helping to prevent leakage.
Supplies and Preparation
Before replacing the pouch, lay out all necessary items on a clean surface. The required supplies include:
- A new pouching system or wafer
- A measuring guide and scissors
- A stoma paste or barrier ring
- Adhesive remover wipes
- A skin barrier wipe or spray
- A clean cloth with warm water
- A disposal bag
A crucial preparatory step is measuring the stoma to ensure the new wafer opening is cut to the correct size. The opening must be snug, fitting approximately 1 to 2 millimeters larger than the stoma’s base to protect the surrounding skin from corrosive output. Using a measuring guide, the correct size is traced onto the back of the new wafer and then carefully cut. A hole that is too large exposes the skin, while a hole that is too tight can cause trauma to the stoma tissue.
Step-by-Step Pouch Replacement
The pouch change begins with the gentle removal of the worn appliance to avoid stripping the top layer of skin. Starting from the top edge, slowly push the skin away from the adhesive barrier with one hand while using the other hand to peel the wafer back. An adhesive remover wipe or spray can be used to help dissolve the bond and minimize discomfort.
Once the old system is off, clean the stoma and surrounding peristomal skin using only warm water and a soft cloth. Avoid soaps containing oils, perfumes, or lotions, as these interfere with the new adhesive’s seal. The stoma can be gently blotted, and slight bleeding is normal. After cleaning, the skin must be completely patted dry, as the new wafer will not adhere properly to moist skin.
Apply a protective layer, such as a no-sting skin barrier wipe or spray, which creates a thin film that shields the skin from the adhesive. Next, place a barrier ring or stoma paste around the stoma. This acts as a gasket to fill any creases or uneven skin surfaces, creating a flush surface for the wafer. The barrier ring can be gently warmed and molded before application to improve its conformity.
Remove the backing from the new wafer and carefully center the system over the stoma. Ensure the stoma protrudes through the opening, with the barrier ring or paste creating a tight seal against the stoma base. Once positioned, firmly press the wafer against the skin, smoothing it out from the center toward the edges to eliminate wrinkles.
To activate the adhesive, place the palm of your hand over the wafer and hold firm pressure for 30 to 60 seconds. The warmth helps the wafer conform to the body’s contours and aids leak prevention. Seal the used supplies in a disposal bag and discard them in the household trash, then wash hands thoroughly.
Managing Stoma Skin Health
Peristomal skin is highly susceptible to irritation, predominantly from prolonged exposure to liquid ileostomy effluent. Maintaining healthy skin is fundamental for a reliable pouch seal, as irritated skin makes adhesion difficult. Redness and raw areas are common signs of effluent exposure, often indicating the wafer opening is too large or the seal is breaking prematurely.
When the skin is moist or irritated, a technique called “crusting” can be used to promote healing. This involves dusting the affected area with stoma powder, which absorbs excess moisture, and then gently sealing the powder with a non-alcohol-based skin barrier wipe or spray. This process can be repeated to build up a protective barrier, allowing the new wafer to adhere over the protected skin.
Fungal infections, presenting as a red or purple rash with small bumps, can occur under the wafer. If suspected, a healthcare professional may recommend topical antifungal powder, used with the crusting technique to dry the area and allow the wafer to stick. Regular inspection of the peristomal skin during each pouch change helps catch minor issues before they escalate.
Determining Pouch Change Frequency
Ileostomy pouching systems are designed to be worn for a period before the adhesive begins to break down, which ranges from three to five days. Establishing a consistent routine within this timeframe maintains peristomal skin integrity and prevents unexpected leaks. Many people choose to change their pouch in the morning before eating or drinking, as the stoma output is less active then.
Certain signs indicate that a pouch change is immediately necessary, regardless of wear time. A persistent itching, burning, or stinging sensation under the wafer indicates that ileostomy output has seeped under the adhesive and is irritating the skin. Visible lifting, rolling, or separation of the wafer, or a noticeable odor emanating from the seal, also signals a compromised system.
Changing the pouch immediately when a leak or irritation is suspected protects the skin. Factors like hot weather causing excessive sweating, oily skin, or a high-output day can shorten the appliance’s wear time. While a new system should not be applied over a compromised one, it is also important to avoid changing the pouch too frequently, as constant removal contributes to skin irritation.