Changing a Bowel Diversion Ostomy Appliance

Performed
Preparation Yes No Mastered Comments
1. Assess:
• Stoma color
• Stoma size and shape
• Stomal bleeding
• Any redness and irritation of
the peristomal skin
• Amount and types of feces
• Complaints
• The client’s and family
member’s learning needs
regarding the ostomy and
self care
• The clients emotional status,
especially strategies used to
cope with the ostomy
• The used appliance for
leakage of effluent
2. Determine:
• The need for an appliance
change.
• The kind of ostomy and its
placement on the abdomen
• The type and size of
appliance currently used and
the special barrier substance
applied to the skin.
• Tape allergy
• If the client has a discomfort
at or around the stoma
• The fullness of the pouch
• If there is pouch leakage or
discomfort at or around the
stoma, change the appliance
3. Assemble equipment and supplies:
• Disposable gloves
• Electric or safety razor
• Bedpan
• Solvent
• Moisture-proof bag
• Cleaning materials, including
 tissues, warm water, mild
soap (optional), wash cloth
or cotton balls, and towel.
• Tissue or gauze pad
• Skin barrier
• Stoma measuring guide
• Pen or pencil with scissors
• Clean ostomy appliance,
with optional belt
• Tail closure clamp
• Special adhesive, if needed
• Stoma guide strip, if needed
• Deodorant (liquid or tablet_
for a non odor-proof
colostomy bag.
4. Select the appropriate time to
change the appliance:
• Avoid times close to meals
or visiting hours
• Avoid time immediately after
meals or the administration
of any medication that may
stimulate bowel evacuation.
Procedure
1. Explain to the client what you are
going to do, why it is necessary,
and how he or she can cooperate.
2. Wash hands and observe other
appropriate infection control
procedure.
3. Provide for client privacy.
4. Assist the client to a comfortable
sitting or lying position in bed or
preferably, a sitting or standing
position in the bathroom.
5. Unfasten the belt, if the client is
wearing one.
6. Shave the peristomal skin well-
established ostomies , as needed
7. Empty and remove the ostomy
appliance
Empty the contents of the pouch
through the bottom opening into a
bedpan
Assess the consistency and the
 amount of effluent
Peel the bag off slowly while
holding the client’s skin taut.
If the client’s pouch is disposable,
discard it and in a moisture-proof
bag.
8. Clean and dry the peristomal skin
Use toilet tissue to remove excess
stool
Use warm water, mild soap, and
cotton balls or a wash cloth and
towel to clean the skin and stoma.
Use a special cleanser to remove
dried, hard stools
Dry the area thoroughly by patting a
towel or cotton balls
9. Asses the stoma and peristomal skin
Assess the stoma for color, size,
shape, and bleeding.
Inspect the peristomal skinfor any
redness, ulceration, or irritation.
Place a piece of gauze or tissue
pad over the stoma, and change it
as needed
10. Apply paste-type skin barrier if
needed
Fill abdominal creases or dimples
with paste.
Allow the paste to dry for 1-2
minutes, or as recommended by the
manufacturer.
11. Prepare and apply the skin barrier
For a solid water or disc skin barrier.
Use the guide to measure the size
of the stoma.
On the back of the skin barrier,
trace a circle the same size as the
soma opening.
Cut out the traced stoma pattern to
make an opening to the skin barrier.
Make the opening no more than
0.3-0.4 cm larger than the stoma
Remove the backing to expose the
sticky adhesive side.
Center the skin barrier over the
stoma and gently press it into the
 client’s skin, smoothing out any
wrinkles or bubbles
For liquid skin sealant
Either wipe or apply the product
evenly around the peristonial skin to
form a thin layer of the liquid plastic
coating to the same area
Allow the skin sealant to dry until it
no longer feels tacky
12. Fill in any exposed skin around irregularly shaped stoma
Apply paste to any exposed skin
area, use a non-alcohol based
product if the skin is excoriated.

Or:
Sprinkle peristonial powder on the
skin, wipe off the excess, and dab
the powder with a slightly moist
gauze or with a applicator
moistened with a liquid skin barrier
13. Prepare and apply the clean appliance
If the appliance does not have
precut opening, trace a circle 0.3-
0.4 cm larger than the stoma size
on the appliance’s adhesive square
Cut out a circle in the adhesive
Peel of the backing of the adhesive
seal
Center the opening of the pouch
over the client’s stoma and aply it
directly onto the skin barrier
Gently press the adhesice skin
backing onto the skin and smooth
out any wrinkles, working from the
stoma outward
Remove the air from the pouch
Place a deodorant in the pouch
Close the pouch by turning up the
bottom a few minutes fanfolding its
end lengthwise, and securing it with
tail closure clamp.
14. Dispose of equipment, or clean
reusable equipment.
Discard a disposable bag in a
plastic bag before placing in a
waste container
 In feces are liquid, measure the
volume. Note the feces character
consistency, and color before
emptying the feces into the toilet or
hopper
Wash reusable bags with cool
water and mild soap, rinse and dry.
Wash soled belt with warm water
and mild soap, rinse and dry
Remove and discard gloves
15. Document the procedure in the client’s record
Report and record:
• Pertinent assessment and
interventions
• Any increase in stoma size
• Change in color indicative of
circulatory impairment
• Presence of skin irritation or
erosion
• Discoloration of the stoma
• Appearance of the
peristomal skin
• Amount and type of drainage
• Client’s reaction to the
procedure
• Client’s experience with the
ostomy
• Skills learned by the client