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SKILL 26 Changing a Fecal Ostomy Appliance

EQUIPMENT 16. Cut skin barrier wafer approximately 1/16 to 1/8 inch
Appropriate drainable ostomy appliance (bag and skin bar- larger than stoma.
rier wafer) 17. Attach a clean pouch to the skin barrier wafer. Make
Skin barriers, e.g., Stomahesive paste and powder sure the pouch is closed. Prevents leaking of stool under-
Clean washcloth, 4 × 4 gauze, or cotton balls neath the wafer during application process.
Warm tap water
Ostomy soap (if prescribed by agency policy) 18. Remove gauze pad from stoma. Makes it easier to visu-
Scissors alize the stoma.
Pen or pencil 19. Remove paper backing from skin barrier wafer. If speci-
Gloves, nonsterile fied by agency policy, apply a thin ring of Stomahesive
paste around the opening on the wafer and fan dry for
PROCEDURE 30–40 seconds or until dry to touch.
1. Gather equipment. Promotes organization and effi- 20. Place the skin barrier wafer on the skin with the opening
ciency. centered over the stoma.
2. Explain procedure to child and family. Enhances cooper- 21. Place hand or warm washcloth over pouch for 3–5 min-
ation and participation and reduces anxiety and fear. utes. Helps seal the wafer to the skin.
3. Wash hands. Reduces transmission of microorganisms. 22. Remove gloves. Wash hands. Reduces transmission of
microorganisms. (Figure 23)
4. Assemble pouch according to instructions.
5. Put on nonsterile gloves. Protects nurse from contact
with body fluids.
6. Empty current ostomy pouch of stool. Prevents acciden-
tal contamination of surrounding environment if stool
accidentally leaks from appliance when removed.
7. Remove current ostomy appliance.
8. Dispose of appliance in appropriate container.
Consistent with body fluid precautions.
9. Remove gloves. Wash hands. Consistent with aseptic
technique.
10. Put on new nonsterile gloves. Consistent with aseptic
technique.
11. Cleanse stoma and surrounding skin with warm tap
water or an ostomy soap as prescribed by agency policy.
Rinse skin well. Pat dry. Prevents injury to mucosa of FIGURE 23 Infant with ostomy bag.
stoma, which has no nerve endings and is very friable,
and to surrounding skin.
12. Assess stoma and surrounding skin.
DOCUMENTATION
13. Measure stoma using measuring guide for appropriate
width and length of stoma at base. Ensures a good fit of 1. Pouch change.
the ostomy appliance without excess skin at the base of 2. Condition and color of stoma and skin.
the stoma exposed to stool. 3. How procedure tolerated.
14. Place gauze pad over stoma while preparing the skin 4. Amount and character of stool.
barrier wafer and pouch for application. Wicks stool
away from skin and ensures a good seal of the wafer to
the skin.
15. Trace pattern of stoma opening onto paper backing of
skin barrier wafer. Ensures better fit and prevents lacer-
ation of the stoma or maceration of periostomal skin.

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