A colostomy is a surgical procedure that creates an opening, known as a stoma, on the abdomen to divert a section of the colon to the outside of the body. This stoma allows stool to pass out of the body without going through the rectum, which is necessary when the lower bowel needs to heal or is diseased. A pouching system, often called a colostomy bag, collects this waste and protects the surrounding skin from irritation. Learning the correct technique for changing this appliance is fundamental to maintaining a secure seal, comfort, and skin health. This guide provides instructions for properly attaching a new pouching system.
Components of Pouching Systems
All colostomy systems utilize two main parts: a pouch for collection and a skin barrier for adhesion and protection. The skin barrier, also referred to as a wafer or flange, is an adhesive material that attaches directly to the skin around the stoma. Its purpose is to shield the skin from digestive enzymes in the output, which can cause breakdown.
Pouching systems are categorized into two primary types based on how these components are connected. A one-piece system has the pouch and the skin barrier permanently joined together as a single unit. This design is often considered lower-profile and more discreet under clothing.
The two-piece system features a separate skin barrier and a detachable pouch, which connect using a plastic ring that snaps or locks together. This configuration allows the pouch to be changed more frequently than the skin barrier, which can remain adhered to the skin for several days. This flexibility minimizes the repeated removal of the adhesive barrier.
Safe Removal of the Existing System
Before beginning the removal process, gather all necessary supplies, including the new pouching system, a measuring guide, specialized adhesive remover wipes, soft tissues, and a disposal bag. Having everything within easy reach minimizes stress and the time the skin is exposed. Proper preparation helps ensure a smooth transition between appliances.
The old system should be removed gently to avoid stripping the top layer of skin, a common cause of irritation. Begin by emptying any contents from the old pouch into the toilet if it is a drainable system. Use one hand to stabilize the skin while the other hand slowly peels the adhesive barrier downward, starting from the top edge.
To aid in removal, an adhesive remover wipe or spray can be used by gently working it under the edge of the barrier as it is peeled back. This technique dissolves the adhesive bond, allowing the barrier to lift away from the skin without undue pulling. Once the system is fully removed, place it immediately into the disposal bag and seal it.
Cleaning and Measuring the Stoma
After the old appliance is removed, the skin surrounding the stoma, known as the peristomal skin, must be meticulously cleaned and inspected. Use lukewarm water and a soft cloth or specialized wipe to gently clean the area, removing any residual adhesive, stool, or moisture. Avoid using standard soaps, especially those containing oils, lotions, or perfumes, as these residues can interfere with the new barrier’s ability to stick securely.
The peristomal skin should then be patted completely dry using a clean, soft towel or gauze. A hairdryer on a low, cool setting can also be used to ensure thorough drying, as a new adhesive barrier will not form a reliable seal on wet or damp skin. During this cleaning phase, examine the skin for any signs of redness, rash, or broken areas, which typically indicate a leak was present in the previous system.
Measuring the stoma’s size is a preparatory step that must be completed with every pouch change, especially in the weeks following surgery when the stoma may shrink. Use a stoma measuring guide to find the diameter that fits snugly around the stoma base without touching the stoma tissue itself. The goal is to ensure only a minimal margin of skin, approximately one-eighth of an inch, is exposed between the stoma and the opening in the new barrier.
A precise fit is the most effective way to prevent leakage and protect the delicate peristomal skin. If the opening is too large, the skin will be exposed to irritating output. If it is too small, the barrier may rub and cause trauma to the stoma tissue. This accurate measurement will then be used to prepare the new appliance for application.
Step-by-Step Application of the New Pouch
The first step in application is preparing the new skin barrier using the measurement just obtained. If the barrier is not pre-cut, use the measuring guide to trace the correct size onto the back of the adhesive wafer. Precision scissors are then used to carefully cut the hole; when using a one-piece system, it is necessary to pull the pouch away from the barrier to prevent accidentally snipping the plastic bag.
Optional accessories, such as a barrier ring or paste, can be applied to the back of the wafer or directly onto the skin to fill in any creases, scars, or uneven contours around the stoma. Barrier rings are useful as they conform to the body’s shape and help create a watertight seal right up against the stoma base. The adhesive must be warmed slightly before application to improve its tackiness and conformability.
Hold the barrier between your hands for 30 to 60 seconds to raise its temperature using your body heat. Next, peel the protective backing from the adhesive and center the barrier carefully over the stoma. It is often helpful to apply the bottom edge first and then gently roll the rest of the barrier upward, ensuring there are no wrinkles or folds in the adhesive that could compromise the seal.
Once the barrier is centered, press it firmly onto the skin, starting from the area immediately surrounding the stoma and moving outward toward the edges. Continue to apply gentle, continuous pressure with the flat of your hand for a full 30 to 60 seconds. This sustained pressure and warmth from the hand allow the adhesive polymers to bond with the skin’s surface, creating a secure, long-lasting seal.
If a two-piece system is being used, the final step involves attaching the pouch to the applied barrier. Align the opening of the pouch flange directly over the barrier flange and press them together until a distinct snap or click is heard, confirming the two pieces are locked securely. For all systems, ensure the drainable end of the pouch is closed with its clip or integrated closure mechanism before letting go.