A colostomy bag, also known as an ostomy appliance, is a collection system worn externally on the abdomen to manage waste from a surgically created opening called a stoma. Routine replacement of this pouching system is necessary to maintain skin hygiene, ensure a secure seal, and prevent irritation of the surrounding skin. This guide provides an overview of the steps involved in a typical appliance change.
Necessary Supplies and Preparation
Gather all necessary supplies before starting the process of removing the old appliance. Essential materials include the new pouching system (one-piece or two-piece), specialized adhesive remover wipes or spray, barrier wipes or spray, a clean, soft cloth or gauze, a measuring guide, scissors if the wafer is not pre-cut, and a dedicated disposal bag.
Choosing the right time for the change can simplify the process, as the stoma continues to function. Many people find that changing the appliance first thing in the morning, before eating or drinking, is the best time because the bowel is less active. Position yourself comfortably, either sitting or standing in front of a mirror, for easy access and visual inspection. Laying out all supplies on a clean surface prevents searching mid-change and reduces the time the peristomal skin is exposed.
Step-by-Step Guide to Appliance Removal
The physical detachment of the used appliance requires a slow, deliberate technique to preserve the integrity of the peristomal skin. Begin by gently lifting one edge of the adhesive barrier, often starting at the top of the wafer. As you peel the barrier back, use your free hand to apply light but firm counter-pressure to the adjacent skin. This “push and pull” action helps prevent mechanical stripping, which is the painful separation of the top layer of skin along with the adhesive.
To minimize trauma, use an adhesive remover product, such as a specialized wipe or spray, to dissolve the bond between the barrier and the skin. Apply the remover directly under the edge of the wafer as you peel it back, easing detachment without forceful pulling. Continue this gentle motion around the entire circumference until the appliance is free. Once the old pouch is removed, place a piece of gauze or a dry wipe over the stoma opening to absorb any immediate waste output while you proceed to skin care.
Post-Removal Stoma and Skin Care
After removing the used appliance, focus on cleaning and preparing the stoma and surrounding skin. Gently cleanse the stoma and peristomal skin using only warm water and a soft cloth or specialized wipe. If using soap, select a mild, residue-free product, as lotions or heavy fragrances can leave a film that prevents the new appliance from adhering securely. Rinse the area thoroughly to remove any soap residue and pat the skin completely dry with a clean towel.
Skin Inspection and Protection
This exposed period is the opportunity to perform a thorough inspection of the peristomal area. Healthy peristomal skin should look similar to the skin on the rest of the abdomen, without significant redness, irritation, or breakdown. Persistent redness, open areas, or an itchy rash may indicate irritation from leakage or a fungal infection, requiring consultation with a healthcare professional. After inspection, products such as stoma powder can be dusted onto moist or irritated areas. Follow this with a skin barrier wipe or spray to create a protective film that shields the skin from waste output and provides a better surface for the new adhesive.
Managing Used Ostomy Waste
The final step involves the hygienic disposal of the used appliance and cleaning materials. If the colostomy bag was drainable, empty the contents into the toilet before removing the bag from the body. For all used pouches, the wafer and pouch should be folded over or sealed to contain residual matter and minimize odor. This sealed unit, along with all used wipes and gauze, should then be placed into a dedicated, opaque disposal bag.
Ostomy appliances, including wafers and pouches, are not designed to be flushed down the toilet and must be placed into household waste. Once the disposal bag is securely tied or sealed, place it into the regular trash bin. This practice ensures the waste is contained, managing odor and maintaining hygiene. Washing your hands thoroughly is the last step in completing the appliance change.