An ostomy is a surgically created opening, or stoma, that diverts waste from the digestive or urinary tract to the outside of the body. The ostomy pouching system is a device designed to collect this output, ensuring the wearer’s comfort and maintaining hygiene. Properly applying this system is the most important factor for protecting the delicate skin around the stoma, known as the peristomal skin. This skin must be shielded from the digestive enzymes and moisture present in the output, which can cause severe irritation and breakdown. A secure seal prevents leakage and maintains healthy skin integrity, allowing the adhesive barrier to function correctly.
Pre-Application Steps and Site Preparation
Before beginning the process, all necessary supplies should be gathered and placed within easy reach, including the new pouching system, skin barrier, measuring guide, scissors, and any accessory products like adhesive remover or barrier rings. The old pouching system should be removed gently to avoid damaging the top layer of skin, a trauma known as mechanical stripping. Specialized adhesive remover wipes or sprays can be used to loosen the bond of the old barrier without causing excessive friction on the peristomal skin.
Once the old system is off, the stoma and surrounding skin should be cleaned thoroughly. Warm water is sufficient for cleansing, but if mild soap is used, it must be completely free of oils, perfumes, and lotions, as these residues can interfere with the new adhesive’s ability to stick. The skin should be patted dry completely using a soft cloth or paper towel, as moisture prevents proper adhesion and promotes skin breakdown. Any wet or weepy areas of irritated skin can be lightly dusted with ostomy powder, which acts to absorb moisture and create a dry surface.
If stoma paste or a protective barrier ring is used to fill in skin dips or creases, it should be applied now to the dry skin or directly to the back of the skin barrier. These products help to create a level plane, which prevents output from tunneling beneath the adhesive wafer and contacting the skin surface. The ultimate goal of site preparation is a clean, dry, and flat surface to ensure a long-lasting, secure connection between the skin and the new hydrocolloid barrier.
Sizing and Customizing the Skin Barrier
The process of accurately sizing the opening in the skin barrier directly determines the success of the pouching system. The barrier opening must fit snugly around the stoma to protect the peristomal skin from corrosive effluent. If the opening is cut too large, it exposes the skin to output, leading to irritation and potential excoriation. Conversely, an opening that is too small can rub against the stoma, causing injury to the tissue itself.
A sizing guide, typically a template with various concentric circles, is used to measure the stoma at its base, where it meets the skin. It is important to measure the stoma regularly, especially in the weeks following surgery, because swelling diminishes and the stoma size may change significantly. The ideal fit allows for a gap of approximately 1 to 3 millimeters, or about 1/8 of an inch, between the edge of the stoma and the adhesive barrier. This small margin accounts for minor fluctuations in stoma size and movement.
For a cut-to-fit system, the determined size is traced onto the paper backing of the skin barrier. Small, curved scissors are then used to cut the opening precisely along the traced line, ensuring the edges are smooth and free of jagged edges that could irritate the stoma. If a pre-sized barrier is used, the correct opening size is selected directly from the manufacturer’s options, eliminating the need for cutting. Proper sizing ensures the adhesive hydrocolloid material can create a protective seal right at the stoma’s base.
The Application Process
With the skin prepared and the barrier customized, the next step is the physical application of the system to the abdomen. If using a two-piece system, the pouch itself should be attached to the flange or skin barrier before application to the body. Warming the adhesive of the skin barrier slightly with the hands just prior to removal of the protective backing can improve its initial tackiness and conformability. This gentle heat makes the hydrocolloid material more pliable, allowing it to better mold to the body’s contours.
The protective backing is carefully peeled away, and the barrier is positioned over the stoma, ensuring the opening is centered. The system should be placed gently onto the skin without stretching the adhesive or creating folds. Once positioned, firm yet gentle pressure must be applied to the entire surface of the barrier, starting immediately around the stoma and working outward toward the edges. This technique helps smooth out any wrinkles and ensures maximum surface contact between the adhesive and the skin, which is essential for a secure seal.
It is beneficial to hold the palm of the hand over the newly applied barrier for 30 to 60 seconds. The warmth and sustained pressure from the hand helps to activate the adhesive polymers and allows the barrier to fully conform to the body’s temperature and shape. If the system includes a tape border, it should be smoothed down last, working from the center outward to ensure it lies flat against the skin. Remaining relatively still for a few minutes after application allows the adhesive to set further, forming a strong, lasting bond.
Maintaining the Seal and Recognizing Skin Issues
Immediately after the system is applied, a thorough check for a secure seal around the stoma should be performed. The goal is to achieve a consistent wear time, typically ranging from three to four days, which is dependent on the integrity of the adhesive bond. A well-applied barrier should feel secure and conform closely to the skin without any gaps or lifting.
Signs that the seal is failing or that output is compromising the skin often include itching, burning, or a noticeable wet sensation beneath the barrier. Visible tunneling, where output can be seen tracking under the edge of the wafer, is a clear indication of a leak and necessitates an immediate change to prevent extensive skin damage. Persistent redness, rash, or small, blister-like lesions on the peristomal skin are common signs of irritant dermatitis, which is usually caused by effluent contact.
For drainable pouches, the system should be emptied when it is approximately one-third full to prevent the weight of the output from pulling the barrier away from the skin. Regular inspection of the skin during scheduled barrier changes is the best way to monitor for issues. If irritation or infection is present, it will hinder the next barrier’s ability to adhere, leading to a cycle of leakage and skin breakdown. Addressing skin issues promptly with appropriate accessory products and ensuring an optimal fit are necessary for long-term comfort and successful ostomy management.