A colostomy bag system, often called a pouching system, is a medical device designed to collect output from a surgically created opening in the abdomen known as a stoma. The system consists of an adhesive skin barrier, or wafer, that adheres to the skin around the stoma and a collection pouch. Learning to properly apply and care for this system promotes skin health and security. This guide provides practical instructions, but it should always be used in conjunction with advice from a medical professional or a specialized stoma care nurse.
Gathering Supplies and Preparing the Stoma Site
Gathering all necessary items ensures a smooth and hygienic change, especially since the stoma may pass stool unexpectedly.
You will need:
- The new pouching system
- A stoma measuring guide
- A pair of curved scissors
- An adhesive remover wipe or spray
- Gentle cleansing wipes or warm water
- A soft cloth for drying
- A disposal bag
The first step involves gently removing the worn system by peeling the adhesive barrier away from the skin, starting from the top edge while applying counter-pressure. Using an adhesive remover wipe can help dissolve the bond and prevent the skin from being stripped or damaged during removal.
After the old system is contained, the peristomal skin—the area immediately surrounding the stoma—must be cleaned thoroughly. Use a soft, non-abrasive cloth and warm water to gently wipe away any effluent residue or dried adhesive. Avoid using soaps that contain oils, perfumes, or lotions, as these residues compromise the adhesion of the new wafer. A small amount of bleeding from the stoma is normal during cleaning, as the tissue is similar to the moist lining of the mouth.
Achieving a completely dry skin surface is necessary for the new system to adhere securely and prevent leakage. Pat the skin dry with a soft towel or cloth, ensuring no moisture remains around the stoma. Use the measuring guide to determine the exact diameter of the stoma, as its size and shape can change over time. The opening cut into the new skin barrier must fit snugly around the stoma, ideally leaving a clearance of approximately one-eighth of an inch.
Securing the Wafer and Attaching the Pouch
The measurement is transferred to the back of the new skin barrier, where a template is traced and cut out using the curved scissors. The opening must be perfectly round and free of jagged edges, which could irritate the stoma or the surrounding skin. A precise fit ensures the skin barrier protects the peristomal skin from corrosive output, which is the leading cause of irritation.
If the skin surface around the stoma has creases, folds, or uneven contours, a thin ring of barrier paste or a moldable ring should be applied directly to the back of the adhesive wafer. This material acts as a caulk to fill gaps between the skin and the barrier, creating a level surface for the adhesive to bond. The paste or ring should be placed close to the inner edge of the cut opening, ensuring it does not overlap the stoma.
The protective backing is peeled away from the adhesive wafer to expose the bonding surface. The wafer should be warmed gently with the hands for about 30 seconds before application; this heat activates the adhesive polymers, promoting a stronger seal. Carefully center the opening of the wafer over the stoma, then gently lay the adhesive onto the skin.
Once the wafer is positioned, apply firm, even pressure to the entire surface, working outward from the stoma to eliminate air pockets or wrinkles. Holding the hand over the newly applied wafer for several minutes continues to warm the adhesive, maximizing the bond’s strength. If a two-piece system is used, the collection pouch is aligned with the flange on the wafer and securely snapped or locked into place with an audible click or visual confirmation. The drainage end of the pouch must then be closed using the clamp or integrated roll-up closure to prevent contents from escaping.
Recognizing and Addressing Stoma Site Concerns
After the new pouching system is secured, a quick visual and tactile check confirms the integrity of the seal and comfort level. The skin barrier should lie flat against the abdomen with no wrinkles or gaps visible, and the patient should not feel pulling or tension. A properly fitted system is designed to be comfortable and secure.
Mild redness immediately after removal is a normal response to the adhesive. However, the surrounding skin should otherwise look healthy, similar to the skin on the rest of the body. Persistent or spreading redness, burning, itching, or small, pimple-like bumps suggests irritation, often caused by stoma output leaking underneath the wafer. If leakage is suspected, the system must be changed immediately, as prolonged contact with effluent can lead to skin breakdown.
When irritation is present, specialized stoma powder can be lightly dusted onto the affected area, followed by a non-sting barrier wipe to seal the powder and create a protective layer. This technique helps dry out moist or weeping skin, allowing the new adhesive barrier to bond effectively. Used pouching systems and soiled cleaning materials should be placed into a small, opaque disposal bag and sealed before being discarded in the regular household trash.