A colostomy bag change involves emptying the pouch or fully replacing the appliance, which is the entire system adhering to the skin around the stoma. Who performs this task depends heavily on the individual’s ability, the care setting, and the complexity of the change. While the goal is for the person with the colostomy to assume responsibility, various trained professionals and support persons are also equipped to assist with this regular maintenance.
The Patient: Self-Management as the Primary Goal
The primary goal of ostomy education is achieving patient independence in managing their own care. Self-management includes frequent emptying of the pouch and full replacement of the appliance system. The pouch should be emptied when it is about one-third to one-half full to prevent the weight from causing the adhesive barrier to loosen. The full appliance, including the pouch and the skin barrier (wafer or flange), is typically changed every three to four days, though this varies based on the product and the patient’s skin condition.
The patient is the ideal person for this task due to their intimate knowledge of their body and comfort level. Self-care allows for an immediate response to issues like itching or burning under the barrier, which can signal leakage and potential skin damage. Performing the change requires manual dexterity and cognitive ability to manage steps like measuring the stoma, preparing the skin, and ensuring a secure, leak-free fit.
Professional Training and Specialized Guidance
When initial training, troubleshooting, or complex care is required, a specialized healthcare professional is the correct resource. The most qualified professional is the Wound, Ostomy, and Continence Nurse (WOCN or ET Nurse). These registered nurses have completed additional education and certification, giving them expertise in stoma health, peristomal skin protection, and appliance selection.
The WOCN’s role is consultative and educational; they establish the initial care plan and teach management techniques to the patient and caregivers. They select the appropriate pouching system to ensure a secure seal that protects the skin from digestive enzymes. WOCNs manage complications like persistent leakage, skin irritation, or changes in stoma size or color. While other Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) may perform routine changes in a hospital setting, the WOCN provides the advanced problem-solving and develops the training curriculum.
Family Members and Non-Professional Caregivers
Family members, spouses, or trained in-home caregivers often provide essential support when the patient cannot manage the care independently. This supportive role is common for pediatric patients, those with severe arthritis limiting dexterity, or individuals with cognitive impairments like dementia. These non-professional caregivers provide physical assistance, such as helping with the full appliance change, and emotional support.
Training for these individuals is fundamental and is usually provided by a WOCN or a visiting nurse before the patient is discharged from the hospital. While a Certified Nursing Assistant (CNA) may be permitted to empty the colostomy bag, whether they can perform a full appliance change often depends on state regulations and the specific policies of the healthcare facility. In the home setting, non-clinical aides or family members who have received comprehensive instruction can perform the full change, but complex situations or signs of skin breakdown should prompt a consultation with a trained professional.