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Ostomy pouch change in 3 easy steps!

My name is Florian, I was involved in ostomy since 2005.  I specialize in Ostomy undergarments and clothing for ostomates.

As an ostomate patient myself for 11 years, I am dedicated to personal involvement with ostomates that I can share my experience and help others, it’s my pleasure to present to you a three step method regarding the ostomy pouch change. 

This method is approximately the same whether you have an ileostomy, a colostomy or a urostomy. Should you have any questions or concerns about your ostomy, it is highly recommended to seek advice from a health care professional. The information presented here is presented to assist you and help you through questions you may have and is for personal reference. All medical questions and concerns should be discussed with your doctor or health care professional. 

Let’s start with STEP ONE. 
Always attempt to have all the ostomy care products available when you when you begin a pouch change. Being prepared makes the process so much easier. Every change requires an examination of the stoma, skin condition and all issue related to ostomy health. That’s why it is best to be prepared for a successful pouch change. You may or may not use certain ostomy products, but you should foresee and have everything available and ready for any contingency.
Please be aware that ostomy pouches and flanges are made in one and two piece designs. For additional questions regarding which would be best for you, consult your doctor or ET nurse, they will be happy to assist you. We will be using the one piece pouch system and the two piece pouch system. Today, I will use the two-piece system. I have two skin barriers in case of an accident, since it is possible to have a defective pouch change, we will be able to change using the extra barrier if need be. Be aware of some overflow; we are unable to control that.  I always have available a deodorant because when changing an ostomy pouch odor is normal and not always pleasant. That’s why I prefer having this available if needed. I also have some ostomy belts; this is a patented ostomy belt which I have designed and has been very successful for many years.  

The adhesive ring matches the skin barrier; it creates a joint between the skin and the barrier. You’ll see how to cut and place it correctly later on. A liquid bandage spray is also recommended. There are TWO liquid bandages types available. Use the product that contains NO ALCOHOL.   Refrain from using any liquid bandage with alcohol. Any liquid bandage should be alcohol free. 
Alcohol has a tendency to irritate skin, even if the skin is not irritated, keeping skin healthy requires you to not use products containing alcohol when changing the ostomy pouch. When cleaning the skin, avoid any product that may contain alcohol, unless you have received a different medical recommendation. 

Let’s prepare now by setting up the ostomy pouch. We will begin by cutting the skin barrier. Stomas are all different sizes and circumferences. Let’s consider the one inch or smaller.  I will take the size-template and I trace an inch-wide circle. Remember to cut a little wider, but not too wide for a comfortable fit. It’s important to always leave some space between the stoma and the skin barrier to avoid rubbing the area around the stoma; it is also more comfortable and avoids having further issues. Leaving some space around your stoma is important. Once you’ve finished cutting, roll your finger in the opening; smooth out the cut area and this will help to avoid hurting or irritating the skin. 

Let’s turn our attention to the adhesive ring. This ring is very important. The ring is two-inches wide approximately, but we don’t need that much around the stoma. We only need use the adhesive which is on the ring to form a seal. It’s like making a toilet seal, for example. If you can see, I’ve made a small loop here. I made this loop because I have a cavity around my stoma that I need to fill.  We have finished with STEP ONE.

Step 2: Cleaning the ostomy apparel.  
Today, I am using the one-piece ostomy appliance. When changing the ostomy pouch, it is very important to always have a bag for disposal of used pouches and flanges. If there is any over flow, you can use a paper towel or allow it to go directly into the bag, thus avoiding any disposal issues. Remove the appliance SLOWLY to avoid any skin damage or injury to the skin surrounding the stoma.  Peel away the used appliance and discard. Gently wipe the skin around the stoma before entering the shower. It is very important to use an unscented and alcohol-free soap. Wash gently the skin around the stoma with a damp soft cloth. 

Wash the stoma and skin area well as it oxygenates the skin and removes soil and bacteria. After three to four days with an attached pouch you will feel much better after a thorough cleaning of the skin area. Washing the stoma is recommended for a good hygiene and healthy skin. After washing the stoma and surrounding skin with soap, remember to rinse well, using your fingers and the washcloth to rinse and remove excess glue from around the stoma.  You can also wash the stoma area with water only, proving the same results.

Using soap allows for clean skin and to make sure that there is no excess old glue left.  The cleaner the skin, the better the new appliance will adhere. Now that this part is completed, remember the skin must be completely dry BEFORE any new application can be attempted. Use a dark coloured towel to dry off your entire body. 

Step 3.  New Pouch Application
Begin by holding the ostomy pouch against you; fold it in two in order to clip it, and make it leak proof.  Add a small drop of anti odor solution in the ostomy pouch to eliminate any bad odors; you can do this even if the pouch has already an anti-odour product in it. Just a drop of anti odor is enough to eliminate unpleasant odours for several days.  You can use your body to warm skin barrier in order to bring it to normal body temperature.  You can now inspect the skin underneath the stoma for any irritation.  This is the highest risk area, there can be some irritation that we do not detect, but irritation can cause issues. 

Peel off the paper from the skin barrier. As I mentioned earlier, I have a small cavity here, so I place the adhesive ring at the indicated spot on the skin barrier, this is at four o’clock. When placing the ring, it is very important that you allow an extra space so that the ring doesn’t come out on the other side when applying the skin barrier. The ring must adhere well on the skin and create a seal around the stoma. Use your fingers to push on the ring to create an airtight seal.

Apply the liquid bandage and the protective powder if needed. These products will assist in healing any irritation you may have. In this case we will assume there is no irritation, so I am not going to apply any bandage or protective powder.  Use the alcohol free liquid bandage spray and let it dry for 30 seconds. The skin should not be sticky. This spray forms a protective film over the skin serving as a skin protector that oxygenates the skin and allows the skin barrier to adhere more firmly.  

Proceed to the skin barrier application. Make sure that it is well centered with the stoma. Apply gentle pressure all around it for a better adhesion. Install the ostomy pouch now; starting from below and centering the two pieces. Listen for the “click” which indicates that the pouch is solidly attached.  If you choose you can apply a small belt. It’s very important to have lower underwear so that it comes right underneath the skin barrier. This helps to avoid any irritation or small pimples. You can lower down the ostomy belt now. 

After changing you’re ostomy apparel, wash your hands in order to eliminate any bacteria or product from your hands and fingers.  It’s better to have dark colored towels.  We have completed the ostomy pouch change in a safe and hygienic manner.

I wish you successful and easy ostomy pouch changes and I hope this has helped assist you in creating a procedure that you can use for great results! 

Copyright C.S.P. Florian Levesque 

This information is on a purely personal and non-medical basis