An ileostomy is a surgically created opening, called a stoma, usually in the lower right side of the abdomen that diverts waste from the small intestine (ileum) outside the body. Because the output from the small intestine is liquid and continuous, a specialized pouching system is required to collect the waste and protect the surrounding skin. Routinely changing this system, which consists of a skin barrier (wafer) and a collection pouch (bag), is a necessary self-care procedure for anyone with an ileostomy.
Essential Supplies for a Change
Preparation begins with gathering all necessary items.
- The new pouch and corresponding skin barrier, particularly if using a two-piece system.
- A measuring guide and specialized ostomy scissors for accurately sizing the opening of the new barrier.
- Accessory products like a barrier ring or skin barrier paste to maintain the integrity of the seal.
- Gentle, non-alcohol based wipes or warm water and a soft cloth for cleansing the skin.
- Adhesive remover wipes for the gentle removal of the old wafer.
- A small plastic disposal bag for the immediate and discreet disposal of the used materials.
Preparation Steps Before Application
The process begins by emptying the contents of the existing pouch into the toilet before attempting removal. This minimizes the risk of spillage and reduces the overall bulk of the used system. Gently peeling the old wafer away from the skin, starting from the top and pushing the skin away from the adhesive rather than pulling the wafer off, helps prevent skin stripping and irritation.
Once the old system is fully removed, the skin around the stoma must be thoroughly but gently cleaned using warm water or non-moisturizing, non-oil-based wipes. The peristomal skin must then be patted completely dry, as the new adhesive will not form a secure seal on moist skin.
Measurement is a precise step. Using the measuring guide, the stoma’s size and shape should be determined. The opening traced onto the back of the new skin barrier should be accurately cut to fit snugly around the stoma, typically leaving only a small gap of about 1/8 inch or 1.5–3mm between the stoma edge and the barrier. A correct fit prevents corrosive ileostomy output from contacting and damaging the delicate peristomal skin.
Applying the New Ostomy System
With the new skin barrier cut to size, any necessary accessory products, such as a barrier ring or paste, can be applied. The barrier ring is typically stretched and placed directly around the opening on the back of the wafer or applied to the skin immediately next to the stoma. Using barrier paste can help fill in any folds or dips in the skin surface, ensuring an even seal.
Before removing the protective backing from the adhesive, warm the skin barrier between the hands. The heat from the hands enhances the tackiness and flexibility of the adhesive. After removing the backing, the wafer should be carefully centered over the stoma, ensuring the opening aligns perfectly without touching the stoma itself.
The wafer is then applied to the skin, starting from the area immediately surrounding the stoma and smoothing outwards. Gentle, even pressure should be applied across the entire surface of the barrier to eliminate wrinkles and fully activate the adhesive. Holding the entire wafer in place with the palm of the hand for several minutes after application uses body heat to further secure the adhesive bond.
If a two-piece system is being used, the final step involves securely connecting the pouch to the flange on the skin barrier. Users should ensure the locking mechanism is fully engaged, often indicated by an audible “click” or snap, to prevent accidental detachment. A final check for seal integrity around the edges of the wafer confirms the system is properly seated and ready to function.
Disposal and Post-Change Care
The contents of the used pouch must be emptied into the toilet before the system is discarded. The used wafer and pouch should then be sealed securely inside a small, opaque disposal bag. This double-bagged waste can then be placed into the general household trash.
Immediately after the change, a brief skin assessment is recommended to check the peristomal area for any signs of irritation, redness, or broken skin that might indicate a previous leak.
If any burning sensation, dampness, or visible leakage occurs, it suggests the seal has been compromised, and the system may need to be reapplied. Addressing leaks quickly prevents prolonged exposure of the skin to the ileostomy output, which can cause significant irritation.