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Changing a Colostomy / Ostomy Pouch PDF Print E-mail

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You all remember the infamous words “practice makes perfect” well these are such true words when it comes to changing and cleaning a colostomy pouch.  For many it feel very awkward and clumsy in the beginning, the best words of advice is to stay relaxed and find any kind of humor you can out of it.  Anger and frustration will only lead to a messy disaster.

Pouches have come a long way over the years and there are many options available to you.  This is definitely not a time to feel alone, talk to your ostomy nurse and go into detail with all your questions, if you don’t have one, find one, if you aren’t comfortable with the one you have, find a new one.  This is one of the most important relationships with a nurse you will form.

In the beginning you will need to cut your own holes in your pouch, for the stoma will need a little time to heal and the swelling will go down.  Once this has happened you can have your nurse help you measure it and to size your pouch for the perfect fit.  You may also try out disposable and reusable bags to see which will work best for you.  This is your body and only you will know it’s reactions and what will end up working out best for you.  There are many on-line companies that carry pouches, systems, and all the extras you will need along with local surgical/ medical supply companies.  Some company’s will send you fee trial packets if you send them a request.

Pouches will need to be changed on average every 4-6 days, sometimes sooner if you find any leakages, or if you feel any burning / itching under the pouch (this could be a sign that stool has gotten there and caused either a rash or fungal infection).  The bacteria in stool can cause irritations to the skin so if you feel the burning or itching check you skin and care for it immediately or call your doctor to describe it and follow their instructions. 
Be prepared when ready to change your pouch, we found it easier to keep all the supplies in a plastic tub so they are readily available.  Have the following supplies available before starting, not all of these are completely necessary every time, but better safe than sorry.

  • Pouch and wafer/barrier or one piece system
  • Washcloths
  • Dry towel
  • Scissors
  • Measuring guide
  • Paste if you use it.
  • Ostomy protective powder (Stomahesive or Hollihesive work good)
  • Shaving razor
  • Adhesive remover
  • Pen and pad of paper

Prepare the pouch
Time to get started by laying out the new pouch: if you have a two piece system you may want to keep it separate until you have cut the hole in the wafer.  If you use adhesive lay it out within easy reach, along with the scissors.

Remove the old pouch
If you have an open ended bag, empty the contents first, makes for a cleaner removal. Carefully separate the barrier from the skin by tenderly lifting it up while pressing down on the skin, don’t pull too quickly, for you can irritate the skin and even tear it.  If you find it resistant on removal use a little adhesive remover, or a washcloth with warm water to loosen the adhesive.

Cleansing the Area
Clean both the stoma and skin thoroughly with a warm wash cloth, a mild soap can be used too, but make sure to rinse it thoroughly.  Hair can also be pulled during removal or get dirtier than skin, keep the area clean shaven to avoid any other problems.  Check the skin and stoma to confirm they look healthy; report anything unusual to your nurse or doctor for any suggestions or advice.  You can also use an ostomy protective powder on irritated areas.  Clean and dry it thoroughly, then sprinkle the powder on, rub it in, and remove any excess for a better barrier sealing.
Make sure you have dried off the skin completely before proceeding to the next step. 

Stoma Measuring:
While the pouch is off take a moment and measure your stoma and record it on your note pad.  Now cut the hole out of the barrier just a little larger than the stoma itself.  If you have a pre cut hole and it is too small, measure it out and re-cut it to the proper size.  If you have a two piece pouch now is the time to attach them together.

Applying the Pouch:

More than likely the barrier will have a protective layer over the adhesive layer, remove that and put the center opening around the stoma with the sticky side to the skin.  Press down for at least 45 seconds and make sure that all edges are snug and sealed; the warmth of your hands will help activate the adhesive.  Some find it helpful for a stronger seal to use a special paste for extra protection.  If your bag is open ended, now would be the time to clamp the end.

With a bit of time and practice you will definitely get the hang of this.  An optimistic approach (sometimes easier said than done) is the key factor on how quickly you will get this down pat.  If you find it frustrating and are struggling through this, contact your nurse and go over the process with them in their office so you can ask any questions in person.

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