Caring for Ostomies

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Changing an Ostomy Appliance

 

Steps To Follow to Change an Appliance
  1. Wash hands, put on gloves, gather equipment and supplies, wash clothes, barrier supplies, etc.
  2. Empty, remove, and discard the old appliance.
  3. Clean around the stoma and inspect for skin breakdown.
  4. Get clean gloves to measure the stoma. You want the barrier you cut to measure about 1/8 inch larger than the stoma. Decide on the size you want to cut for the barrier.
  5. Cut the barrier out of the center of the pouching system. Then, peel off the backing to apply it to the skin.
  6. To provide a better seal and extra protection against leakage, you can apply a ring of stoma paste to the edge of the ring as an additional measure to help it stick.
  7. Stick the pouch system to the skin pressing it firmly around the stoma. Seal all edges entirely by pushing all around them.
  8. Please leave a little air in the bag so it drains well. Clamp the end of the bag closed.
  9. Clean up supplies and discard gloves.

The following YouTube video demonstrates how to perform the task properly.

VIDEO: Ostomy Bag Pouch Change

Produced by RegisteredNurseRN

 

VIDEO:  Family Caregiving Series: Caring For and Maintaining Ostomy Bags — AARP

Produced by AARP

Suggestions:
  • Consider having at least two pouching systems to wear and one ready to use. The backup is handy with little warning if you suddenly need an appliance change.
  • Though most pouches are odor-free, add pouch deodorants for odor-free assurance. Avoiding fish, eggs, onions, and garlic is also helpful. 
  • New stomas take approximately 6-8 weeks to shrink to their final size; Therefore, buying items based on the stoma’s size should be delayed for six-eight weeks. 
  Colostomy Irrigation

 Perform colostomy irrigation for two primary reasons  (1) to remove excessive stool from the colon or (2) for bowel training.

     When performed for bowel training, the procedure is conducted each day simultaneously using warm water (about 1000 ml) and being as consistent as possible so that the bowel forms an expectation for evacuating at a specific time each day. The process takes about one hour:  5-10 minutes to put in the solution but forty minutes or so to complete the returns.

     When bowel training is successful, the individual no longer needs to wear a colostomy bag. Instead, they can wear a cap over the stoma. As a result, they have more freedom of movement in their lives. Unfortunately, bowel training is not an option for individuals with ileostomies due to having liquid stools frequently throughout the day.

     The following YouTube video reviews the process of Colostomy Irrigation.

VIDEO: Colostomy Irrigation Procedure Care

Produced by RegisteredNurseRN

Steps for Performing a Colostomy Irrigation
  1. Gather supplies – colostomy irrigation sleeve, drainage pouch clip, ostomy belt, lubricant, cone, tubing,
  2. Fill the irrigation bag with warm water and hang it from an IV pole or another device that allows for the gravity flow of water. The bag needs to be higher than the family member’s stoma; The height of the bag should be such that the bottom of it is level with the individual’s shoulder.
  3. Prime the bag and tubing to remove all the air.
  4. Remove the ostomy appliance if one is in place and clean around the stoma.
  5. Place an irrigation sleeve over the stoma. If the sleeve doesn’t have adhesive, secure it with an ostomy belt. If they use a two-piece pouching system, snap off the pouch, save it, and snap on the irrigation sleeve.
  6. Place the open end of the sleeve into a bedpan or toilet
  7. Lubricate your gloved little finger and insert it into the stoma. The stoma will likely tighten around your finger; wait for it to relax for just a bit. When it does, proceed with feeling the inside of the stoma to see which direction the bowel angles.
  8. Lubricate the cone generously. Bring the cone up through the irrigation bag. Insert the cone into the stoma following the angle identified previously. Insert gently but snugly.
  9. Have your family member take slow, deep breaths to reduce any cramping or discomfort caused by the introduction of the cone.
  10. Unclamp the tubing and allow the water to flow over 5-10 minutes until it has entered the colon. Slow down the flow and encourage slow, deep breaths if cramping occurs.
  11. After the water is in, keep the cone in place for 15 minutes and then unclamp the sleeve to allow the bowel to evacuate over the next 30-40 minutes.

VIDEO: How to Empty a Colostomy Bag

Produced by:

American College of Surgeons

Applying a skin barrier and pouch

     Skincare is very important in preventing skin breakdown from leakage around the appliance  Furthermore, obtaining a good seal when securing the appliance is equally important in keeping the skin from harm from corrosive enzymes in stool.

Here’s how to fit a skin barrier and a pouch together before applying them to your skin.

  1. Obtain a stoma measuring guide and determine the current size of your stoma.
  2. Trace the appropriate size circle carefully on the back of the skin barrier.
  3. Cut the circular opening in the skin barrier (or cut the shape of the stoma if it’s not circular). Smooth any rough edges with your fingers.
  4. Remove the backing from the skin barrier and apply barrier paste or moldable barrier ring, as needed, along the edge of the circular opening.
  5. Center a one-piece system over the stoma, adhesive side down, and gently press it to the skin.
    • When using a two-piece system, apply the wafer and gently press the pouch opening onto the ring until it snaps into place. When using a two-piece adhesive coupling, line up the pouch’s adhesive portion to the “landing zone” of the wafer  Press together for adhesion. The pouches used in a two-piece system can be attached to the wafer before application and applied like a one-piece system. Other two-piece systems have a floating flange that allows the user to insert the fingers underneath so that snapping the flange to the pouch doesn’t exert pressure. 
  6. Close the bottom of the pouch by folding the end upward and using the clip that comes with the product, or close the integrated closure system. 

Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 195.

Urinary ostomies are otherwise known as urinary diversions

     The two types of permanent urinary diversion are Ileal Conduit and the continent urinary diversion or Indiana pouch.

Ileal Conduit

     A segment of the ileum is cut out, and the two ends are sewn together. Then, the two ureters are disconnected from the bladder and connected to the ileum segment created. Finally, one end of the ileal segment is closed with ureters with sutures, and the other is brought through the stomach to form a stoma.

Continent Urinary Diversion

     The ureters are attached to a segment of the ileum, and cecum  Urine drains out periodically by inserting a catheter into the stoma. 

Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 195.

Home Care Tips for Continent Urinary Diversion Systems
  • The pouch can become heavy and pull away if not emptied frequently because the bladder continuously produces urine — plan to empty the bag at least every 2-3 hours until you learn your pattern. 
  • Catheters may be reused for up to one month if washed thoroughly with soap and water, but discard them if they become discolored or cracked. 
  • Stomas bleed easily. Be careful to protect them against abrasions but also don’t be alarmed if they occasionally bleed.  
Disposable Urinary Diversion Pouching Systems

     Options for the disposable pouching system include a one-piece disposable system with a spout closure and a two-piece drainable disposable pouch with a skin barrier. The one-piece system comprises a transparent or opaque odor-proof plastic bag with attached adhesive backing. Some bags have microporous tape edges or belt tabs. The spout opening enables easy draining. 

     The two-piece drainable, disposable pouch with a separate skin barrier permits more frequent changes. Also made of transparent or opaque, odor-proof plastic, the style comes with a belt tab and usually snaps to the skin barrier with a flange mechanism. Newer two-piece pouches have an adhesive coupling. As a result, the pouch sticks to the wafer, allowing greater flexibility and comfort. 

Reusable Pouching Systems

     A reusable sturdy, opaque, hypoallergenic plastic pouch is available with a separate custom-made faceplate and O-ring. The device has a 1-3-month life span depending on how frequently you empty the bag. The benefit is that it has a firm faceplate, may be used by those who need something with less sensitivity to the adhesive, and saves money. 

Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 805.

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