Changing an Ostomy Pouch: Procedure (Nursing)

by Samantha Rhea, MSN, RN

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      Slides Ostomy Pouching Systems Nursing.pdf
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      Review Sheet Changing an Ostomy Bag Nursing.pdf
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      Clinical Skills Nursing Reference List.pdf
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    00:04 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.

    02:29 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.

    03:49 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.

    04:12 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.

    04:25 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.

    06:12 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.

    07:26 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.

    09:00 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.

    09:32 Now take your time here because if possible you want as smooth and comfortable as possible.

    10:05 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.

    10:55 And guys sometimes it's not very pretty but that's okay.

    11:02 Okay so now I can get rid of my stoma paste.

    11:09 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.

    11:38 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.

    12:27 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.

    13:08 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.

    13:24 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.

    About the Lecture

    The lecture Changing an Ostomy Pouch: Procedure (Nursing) by Samantha Rhea, MSN, RN is from the course Ostomy Pouching Systems (Nursing).

    Included Quiz Questions

    1. Measure the stoma using the stoma-measuring guide.
    2. For a one-piece pouch, select the size that matches the stoma.
    3. Ensure that the stoma site is dry before adhering appliance.
    4. The measurement should allow a 2 cm perimeter around the stoma.
    5. For a two-piece pouch, cut a hole slightly smaller than the stoma size.
    1. In the two-piece system, the tail folds and Velcroes for closure.
    2. In the one-piece system, the wafer disconnects from the pouch.
    3. In the two-piece system, the closure is a regular clamp.
    4. In the two-piece system, the wafer does not disconnect from the pouch.
    1. Fills the gap between the stoma and the wafer
    2. Absorbs extra moisture
    3. Glues the wafer to the skin
    4. Numbs the area before the appliance
    1. Always measure before cutting and fitting the wafer.
    2. Cut the wafer on the line that correlates with the stoma measurement.
    3. Fit the wafer around the stoma with a minimal amount of skin showing.
    4. Ensure there is a 4 mm gap between the ostomy and wafer.
    5. Cut from the outside into the middle of the wafer.
    1. Apply the paste around the wafer before application.
    2. Apply the paste around the stoma before application.
    3. Apply the paste while the skin around the stoma is moist.
    4. Apply the paste after the wafer is placed around the stoma.
    1. Attach the wafer and pouch before applying it to the stoma.
    2. Attach the wafer to the stoma and then apply the pouch.
    3. Ensure the wafer seal is loose.
    4. Ensure no stoma paste is showing after the wafer is sealed.
    1. Close the clamp.
    2. Encourage the client to ambulate.
    3. Leave the clamp open.
    4. Write the date and time on the bag.

    Author of lecture Changing an Ostomy Pouch: Procedure (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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