An ostomy is a surgically created opening, called a stoma, which diverts the path for waste from the body, typically due to disease or injury. Since the stoma lacks a muscle sphincter to control output, an ostomy pouching system is worn over the opening to collect the waste. This system consists of an adhesive skin barrier (wafer) that attaches to the abdomen and a collection pouch. Learning to change this appliance is necessary for managing an ostomy, ensuring hygiene and protecting the surrounding skin.
Preparation and Necessary Supplies
Changing an ostomy system requires meticulous preparation. All necessary materials must be gathered and laid out in a clean, private, and well-lit area before the old appliance is removed. Having supplies within reach prevents interruptions and minimizes the time the skin is exposed.
Supplies include a new pouching system (one-piece or two-piece) and a stoma measuring guide for a custom fit. Curved scissors are needed if the wafer is not pre-cut. Accessories like barrier paste or moldable rings can fill uneven skin contours to improve the seal, and adhesive remover aids in gentle removal. Cleaning requires warm water and a soft cloth or specialized non-alcohol wipes, followed by a disposal bag for the used appliance. Hands must be thoroughly washed before starting to prevent bacteria introduction.
Removal and Peristomal Skin Assessment
The first step is the gentle removal of the old pouching system to prevent skin stripping. Skin stripping occurs when layers of the epidermis are torn away with the adhesive, causing damage. To mitigate this risk, use an adhesive remover product applied at the wafer’s edge while slowly peeling the barrier back.
Once the appliance is removed, the stoma and the surrounding peristomal skin must be immediately cleaned. The skin should be carefully wiped using warm water and a soft cloth or specialized wipes to remove residual waste and adhesive. Cleaning the stoma should not be painful, as it has no nerve endings, and a small amount of bleeding is generally normal.
Following cleaning, thoroughly inspect the peristomal skin before applying new products. Healthy peristomal skin should appear intact and free from redness, rash, or open areas, similar to the rest of the abdomen. Note any signs of irritation, such as persistent redness or blistering, which often indicates leakage beneath the adhesive. If the skin is moist or compromised, lightly dust stoma powder onto the affected area, brush off the excess, and then apply a skin barrier protective wipe to seal the area.
The Step-by-Step Guide to Applying the New System
Applying the new wafer requires precision, starting with measuring the stoma to ensure the aperture is the correct size. Since the stoma may change size and shape, measuring it before every change is recommended. The opening should fit snugly around the stoma base, leaving only a minimal gap of about one-eighth of an inch of exposed skin. This prevents waste output from contacting the peristomal skin.
Use the measuring guide to trace the correct shape and size onto the back of the new adhesive wafer, then carefully cut the opening with curved scissors. Cutting the hole too large exposes the skin to corrosive output, while cutting it too small can injure the stoma. Barrier paste or a moldable ring should be applied around the inner edge of the wafer or directly onto the skin adjacent to the stoma.
Before application, peel off the backing paper. The adhesive surface can be gently warmed with the hands or a low-setting hairdryer to activate the adhesive properties, promoting better initial tack and a secure seal. Center the wafer precisely over the stoma, starting from the bottom and smoothing upward to eliminate wrinkles or air pockets.
Once positioned, press the wafer firmly against the skin for several minutes, using the warmth of the hand to mold the adhesive to the body’s contours. This sustained pressure ensures a tight seal around the stoma. If using a two-piece system, securely snap or lock the collection pouch onto the wafer’s flange.
Maintaining Adherence and Troubleshooting Common Issues
After applying the new system, maintaining adherence depends on achieving a complete seal. Applying gentle, sustained pressure to the wafer for up to five minutes helps the adhesive conform to body temperature and skin topography. This initial bond determines the pouching system’s total wear time, which ideally ranges between three and five days for most users.
Common issues between changes relate to minor leaks or skin irritation caused by output contacting the skin. If a small leak is suspected, the pouch system should be immediately changed, as minimal seepage quickly leads to painful peristomal skin damage. Persistent leakage often points to an improperly sized stoma opening, a need for convexity to manage a flush or recessed stoma, or the necessity of using barrier rings to fill in skin folds.
Other problems include “ballooning” (gas buildup) or persistent odor, which can often be managed with filtered pouches or dietary adjustments. Skin irritation presenting as a rash with small, pimple-like bumps may indicate a fungal infection and requires specialized treatment. Contact a Wound, Ostomy, and Continence (WOC) nurse or other healthcare professional immediately if the skin becomes severely broken, if the stoma changes color (e.g., to purple or black), or if there is excessive, uncontrolled bleeding.