Replacing the pouch and attached skin barrier is a manageable part of life with an ostomy. The pouching system is designed to collect waste from the stoma, a surgically created opening, and a regular change is necessary to maintain a secure seal against the skin. Consistent and correct appliance changes are fundamental for preserving the health of the peristomal skin, which is the skin immediately surrounding the stoma. Mastering this process helps prevent leaks, reduces skin irritation, and supports a better quality of life.
Gathering Your Supplies and Setting Up
Preparation for a smooth appliance change begins with a complete set of supplies laid out within easy reach. You will need a new pouching system, which includes the flange or skin barrier and the pouch itself, a stoma measuring guide, and small, curved scissors if your barrier is “cut-to-fit.” Adhesive remover wipes or spray, a clean washcloth or gauze, and warm water for cleaning are also needed.
It is helpful to also have accessory products on hand, such as barrier rings or paste, to manage uneven skin contours. A plastic disposal bag and a towel placed on your lap or workspace will help manage any unexpected output and keep the area clean. Choosing a time when the stoma is less active, often first thing in the morning before eating or drinking, will simplify the process.
Removing the Old Appliance and Stoma Skin Care
Begin by gently removing the old pouching system to protect the peristomal skin from trauma. Slowly peel the skin barrier away from the skin, starting from the top and rolling it downward. As you peel the barrier with one hand, use the other hand to press down gently on the skin immediately adjacent to the adhesive, which helps minimize tension and prevent skin stripping.
If the adhesive is particularly strong, an adhesive remover spray or wipe can be used to dissolve the bond as you progress with the removal. Once the appliance is removed, the stoma and surrounding skin must be cleaned using only warm water and a soft cloth or gauze. Avoid using scented soaps, baby wipes, or oily cleansers, as residues can compromise the adhesion of the new barrier.
The skin must then be patted completely dry with a clean, lint-free towel or gauze. A hairdryer on a cool, low setting may be used to ensure the area is fully moisture-free, as any residual moisture will prevent the new skin barrier from adhering properly. Inspect the peristomal skin, which should appear intact, though a little temporary redness immediately after removal is normal. Finally, use the measuring guide to determine the stoma’s current diameter, as the size and shape can change over time.
Attaching the New Pouching System
Accurate sizing of the skin barrier opening is the first step in applying the new system. Using the measurement taken, mark the corresponding size onto the protective backing of the new skin barrier. Cut the opening with small, curved scissors, ensuring the hole is snug around the stoma, allowing no more than a 1/8-inch gap between the stoma and the barrier edge. This clearance is necessary to protect the skin from contact with corrosive stoma output.
If your skin barrier is not pre-cut, smooth the inner edge of the cut opening to eliminate any rough edges that could irritate the stoma. Next, apply any necessary accessory products to create a flat, secure surface for the wafer. Barrier rings or seals should be stretched or molded to fit closely around the stoma base, or stoma paste can be used to fill in any folds, creases, or scars on the abdomen. Paste functions as caulk to create a smooth plane, not as an adhesive itself.
Before application, warm the skin barrier between your hands for a minute or two, as the heat helps activate the adhesive polymers for a better initial bond. Peel the protective backing from the barrier and, while leaning back slightly to flatten the abdominal skin, center the opening over the stoma. Apply the barrier from the bottom up, pressing firmly around the stoma first and then outward toward the edges, being careful to avoid wrinkles.
Maintain firm, gentle pressure over the entire barrier for at least 30 to 60 seconds, using the warmth of your hand to secure the seal further. This heat-activated adhesion helps achieve optimal wear time. If you are using a two-piece system, align the pouch over the flange and press firmly until you hear a distinct click or feel the locking mechanism secure the two components.
Troubleshooting Leaks and Skin Irritation
A secure seal is the goal of every change, but issues can arise. Signs of a failing seal include persistent itching, burning, or a visible presence of output underneath the skin barrier. If a leak is suspected or confirmed, the entire pouching system must be removed and replaced immediately to prevent peristomal skin damage.
Minor skin irritation, such as mild redness, can often be managed with a technique called “crusting,” where stoma powder is lightly dusted onto the irritated area and then sealed with a skin barrier wipe to form a protective layer. This crusting technique helps the new barrier adhere to the damaged skin while promoting healing. Persistent irritation, deep redness, open sores, or a rash that does not improve after a few changes may indicate a fungal infection or a need to re-evaluate the appliance fit. In these cases, contact a Wound, Ostomy, Continence (WOC) nurse, who can assess the stoma and skin, recommend product adjustments, or suggest specific treatments.