Now before we get started, the first
thing we have to do is know what size
that stoma is because that's going to be
important regarding our appliances.
So you're going to use your guide and measure the
stoma, now when we're talking about measuring the
stoma, when you're placing that over the stoma it
needs to be very close to the size of the stoma.
Notice that you don't want it too big, you also
don't want it really cutting into that stoma,
so if you take a look at this image here it fits
really nicely around so that's what you want to
do in regard to measuring. Now we talked about
variations in system, there may be a one-piece
so if that's the case, you want to select the size
that matches the stoma, now for a two-piece pouch
there's a little backing to that, you can take
that guide compare it to the two-piece system
and then you may have to use your scissors and cut
a hole just slightly bigger than that stoma size
into the adhesive back and again that's for the
two-piece system. Now it's a good idea to gently
wipe around the stoma and make sure that
skin is clean and it's dry and again key point
it's important here that we make sure it's nice
and dry before we try to adhere our appliance.
Now if necessary you can
use your stoma paste here,
so this is really helpful to help prevent any
leakage or maybe fill in those gaps if maybe the
stoma, the appliance, excuse me, is just a little
bit too big, so this is really helpful for that.
So if you do use the stoma paste, give it about a
minute or so to dry. Now once we're applying that
system, if we're using the one-piece or if it's a
two-piece, you're going to take that and remove the
adhesive back and you're going to apply it to your
patient. Now notice if there's some pain when you
try to put that on there and apply pressure, you
may want to apply the pouch to the back if it's a
two-piece before putting it on your patient. Now
once we've applied our appliance to our patient,
make sure that ostomy is closed, or that bag, so
this is where we're going to use our clamp here.
Now is a great time to have the patient
just sit back, relax for about five minutes,
that way we know that the appliance is
adhered safely and comfortably to the patient.
Hi guys, let's take a look at
how we change an ostomy pouch.
So I've already removed the old soiled pouch,
I've done my hand hygiene and I put on new gloves.
So now let's take a moment to look at the
equipment, okay so let's pause here first,
so one thing to know is anytime you're changing
out an ostomy obviously there's going to be
potential stool coming from that so make sure
your patient has extra towels or absorbent pads
underneath them also sometimes you may have to
move a little quick so just keep that in mind,
but for this sake I really want to take some
time and get you familiar with the equipment
and the process. All right, so now let's take
a look at the equipment itself so what I've got
here for you is a couple of different systems.
I've got a one-piece pouch, I've also got our two-
piece pouch here so what you're going to notice the
difference is exactly that, one-piece versus two.
So we're talking about one, notice the back half
all of that is all together so that's really nice
it's just one system that's together, also notice
on this you're going to see the difference on the
clamps which is good to see. This is a regular
clamp that you may see on many different pouches
also you've got the two-piece over here,
so let's take a look at how this differs.
So the nice thing here is you've got
the wafer which is what we call this
and then you've got the pouch itself
so again you see how this is two-pieces
and this adheres to here. So here on our
one-piece we have a traditional clamp,
now on our two-piece we have a different type
of closure so let me show you how that works.
So we're going to take the tail end and
we're going to just keep folding this
fold it again and then fold it again.
So you notice the main thing what I'm trying
to do is get to the white piece and make sure
those two white pieces are going to meet, so these
are going to close down with velcro and adhere,
so push this down and really make sure that you
get this sealed. So I like to just make sure I
run my fingers across because if it's not sealed
that could definitely be an issue for the patient.
Okay, so that's our two different types of devices
and then our two different types of closures.
Now let's take a look at the stoma paste, now
sometimes you may need this if maybe the patient's
skin around the stoma, maybe is irregular or bumpy
and we need to kind of help with the seal here.
So the stoma paste is really great because what
this is going to do, we would apply the stoma paste
around and this is going to go around the skin
of the stoma and help to fill in that gap between
around the stoma and the wafer when we apply it
to the patient. Next we have some barrier powder,
so sometimes you're going to need this again and
sometimes you won't. There's a lot of different
equipment that can come with regarding ostomies,
so this is really helpful because if you have
some irritated or excoriated skin, the barrier
powder is really nice to absorb some excess
moisture there for you and don't forget the
really important piece. Here is going to be your
measuring, your stoma device so this is going to
come with your system, so as you notice here
this folds out and there's lots of different
sizes, can you see this one? This one's pretty
large right? Honestly you're probably not going to
use this one so much but here's some variant
sizes of stomas and we're going to use this
to measure and use with fitting our device.
And again, to clean the skin always good
to have a washcloth or a gauze or something
like that around and don't forget your scissors
as well because you're going to need this to cut
the wafer size to the size of the stoma
so that's a good look of our equipment,
now we can go ahead and get started. So
before we get started if you remember of
course we've already removed the old soiled
ostomy pouch that the patient's already used
so before we get started don't forget to measure,
this is key because this is going to matter
where we cut our devices. So now we're
going to take our measuring device
and we're going to measure, so really we
just simply place it over the stoma itself.
So as you can see, and this has got little markings
here for you, the 32 millimeter, see how that
doesn't even go around the stoma that would be
way too tight, we don't want to use that. If I go
around here at the 50 millimeter that's definitely
way too big right, too much gap. Really, what
you're going to want to see is that it's going to
fit nicely in as minimal area open as possible.
Okay, so this one looks like a really
pretty good fit, this is our 38 millimeters,
see how it hugs nicely around the stoma and
of course if you remember sometimes stomas
are going to vary on size and shape, you may not
get a perfect circle but see how this is really
nicely snug around there but there's also just a
little bit of room and it's not too tight so this
is a great measurement for us. So for our patient
we will be using the 38 millimeter measurement
alright so now that we've measured that now we
can remove this. So now let's take a look of
how we would get our appliance to fit, so if I'm
looking at the one-piece, so if you remember again
it's really nice, it's just one-piece. So if you
take a look here notice there's measurements also
on the bag itself that makes it really helpful
so if you notice these lines here's the 25,
the 32, oh and then there's the 38 so this
is really nice here so really all I would do
is around that 38 millimeter line, I would
take my scissors cut all the way around to
fit my stoma so that's the one-piece device.
Now if I'm going to use the two-piece device,
nice thing is because it's two-pieces I
can take this off and I'm going to look for
that same measurement here's 25, 32 and 28
so again excuse me the 38. The 38 is where
we measured so this is what I'm going to cut
around so I'm going to show you that now.
So we're going to apply the two-piece
just so you can see a little bit better
so I'm just going to take my
scissors, cut down to the 38
and just really carefully cut around this line.
Now take your time here because if possible
you want as smooth and comfortable as possible.
Okay, so just I removed that section
with my scissors and I'm going to
remove this little piece here
so I don't need this anymore,
so just to take a look just so you can see again
notice that here's the 38 millimeter mark and I
just really traced around with my scissors here
and that's where we're going to go for over stoma,
so now I can again can get rid of this. Now
is a great time to apply the stoma paste
and again if you remember this is really
helpful if there's any little gaps between
around the stoma and between the wafer
and this is going to help reduce leakage
so I'm going to take my stoma paste and just give a
thick little circle around the wafer opening.
And guys sometimes it's not
very pretty but that's okay.
Okay so now I can get rid of my stoma paste.
And you may need to
just make sure it's applied
around that area. Okay so now that we've got
this ready, now we can apply it to our patient
so it's important to make sure the skin is
prepped so if that's not the case,
make sure that you get a nice wet washcloth
or something like that make sure the skin is
clean and also remember make sure you pat
that dry so this is really important here.
So now we can apply it to the patient,
so one thing I want to show you just so
you can see how this fits around now with
normally with a live patient it's much more
comfortable if you apply the one-piece to
the other piece and then apply it one time
so that's much better but so you can see how
this fits I'm going to apply this itself.
So I put this side down, this is
going around the patient's stoma
and see how that nicely fits
around that's exactly what we want
so we're just going to make sure this seals
around it and then make sure we smooth
down these corners really nice and smooth try
to eliminate any wrinkles as much as possible.
Sometimes it can get a little messy with the paste
and again really important to try to make sure
this is adhered down and all those wrinkles are
out. Okay, so again I showed you this way
because that way you can kind of see for this
demonstration how it's going to fit around now if I
was going to do this with a live patient again,
I would take my other pouch put it towards
the wafer and then do it all at once
so you're not putting excess pressure on the
patient, so now I'm going to put the bag on.
And remember this ring just snaps into it
and again you see how much force I'm going to
have to use, that's why it's a great idea
to put the wafer and the bag on all at once.
Okay, so now that's applied, now notice there's
some of the stoma paste that's totally okay,
main thing we really want to visualize the stoma
here and make sure it looks reddish or pink,
that's really what we want to see also really
important before you leave make sure that the
closure clamp is closed because you don't want
any contents leaking on the patient's skin.
Now once the procedure is done make sure
you have the patient rest for a little bit
that way we know this is going to adhere
nicely and then we're done with our procedure.