A colostomy pouching system is a device designed to collect stool that passes through a surgically created opening in the abdomen called a stoma. The system has two main parts: a collection pouch and an adhesive skin barrier (wafer or flange) that attaches to the body. Proper application technique is paramount because the adhesive barrier serves as the primary defense for the peristomal skin surrounding the stoma. An inadequate seal permits effluent to contact the skin, which can rapidly cause irritation and breakdown. Maintaining a secure and well-fitting appliance is the most effective way to prevent leaks, protect skin health, and ensure comfort.
Gathering Supplies and Skin Preparation
Before removing the old appliance, lay out all necessary supplies for a smooth transition. These supplies should include the new pouching system, a stoma measuring guide, curved scissors, an adhesive remover wipe, skin barrier accessories (like paste or rings), and a disposal bag. Once the old barrier is gently peeled away, meticulously clean the peristomal skin to prepare the surface for the new adhesive. Wash the skin gently using warm water, optionally with a mild, oil-free soap, to remove any residual output or adhesive.
Thorough drying of the skin is essential, as moisture significantly compromises the ability of the new adhesive to bond securely. The peristomal skin must be completely dry before proceeding with application. Next, the stoma’s size and shape must be measured accurately using a measuring guide. This is especially important in the first few months after surgery as the stoma shrinks, and this measurement guides the cutting of the new skin barrier to ensure a precise fit.
Step-by-Step Guide to Pouch Application
The process begins by preparing the new skin barrier to match the stoma’s current dimensions. Cut an opening that is only one to two millimeters larger than the stoma itself. This tight clearance minimizes exposed peristomal skin, preventing output from eroding the skin barrier prematurely. If the skin surface is uneven due to scars or creases, apply a barrier ring or paste directly around the stoma or to the back of the wafer to create a smooth, leak-proof platform.
Once the barrier is correctly cut and any accessories are applied, peel off the protective backing from the adhesive. Warming the barrier slightly with the hands helps activate the adhesive properties before application. Carefully center the opening over the stoma, ensuring the bottom is aligned correctly for a natural path of output into the pouch. Press the barrier onto the skin, starting immediately around the stoma and moving outward toward the edges in a smooth, continuous motion.
Apply pressure evenly across the entire surface of the barrier for approximately 30 to 45 seconds to fully secure the seal and eliminate any wrinkles or air pockets. In a two-piece system, attach the pouch to the applied barrier with an audible click or snap, confirming the secure connection. If using a drainable pouch, the tail end must be meticulously rolled or folded and secured with its integrated closure clip before the system is complete.
Maintaining the Seal and Recognizing When to Change
Immediately following application, check the seal by running a finger gently around the edge of the barrier, ensuring it lies flat against the skin without lifting or creases. For drainable pouches, maintain the seal by emptying the pouch when it is approximately one-third to one-half full. Allowing the pouch to become overly heavy puts downward tension on the adhesive barrier, which can cause the seal to break.
The expected wear time for a pouching system ranges from three to seven days, depending on factors like skin moisture, activity level, and the specific product used. Extended-wear barriers are chemically formulated to resist the erosion caused by liquid output for a longer period. This wear time is only a guideline, and the appliance should be changed proactively, not reactively.
A failing seal often presents with subtle signs that require attention before a full leak occurs. The earliest indications include a persistent itching or burning sensation beneath the barrier, signaling that intestinal output may be contacting the skin. A noticeable odor is another sign, as modern pouches use charcoal filters to manage gas and should not emit smells unless the seal is compromised. Visible lifting or “melting” of the barrier edges, especially nearest to the stoma, suggests the seal is degrading and requires a complete system change.