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SKILL 26

Changing a Fecal Ostomy Appliance

EQUIPMENT
Appropriate drainable ostomy appliance (bag and skin barrier wafer)
Skin barriers, e.g., Stomahesive paste and powder
Clean washcloth, 4 4 gauze, or cotton balls
Warm tap water
Ostomy soap (if prescribed by agency policy)
Scissors
Pen or pencil
Gloves, nonsterile
PROCEDURE

16. Cut skin barrier wafer approximately 1/16 to 1/8 inch

larger than stoma.
17. Attach a clean pouch to the skin barrier wafer. Make
sure the pouch is closed. Prevents leaking of stool underneath the wafer during application process.
18. Remove gauze pad from stoma. Makes it easier to visualize the stoma.
19. Remove paper backing from skin barrier wafer. If specified by agency policy, apply a thin ring of Stomahesive
paste around the opening on the wafer and fan dry for
3040 seconds or until dry to touch.

1. Gather equipment. Promotes organization and efficiency.

20. Place the skin barrier wafer on the skin with the opening
centered over the stoma.

2. Explain procedure to child and family. Enhances cooperation and participation and reduces anxiety and fear.

21. Place hand or warm washcloth over pouch for 35 minutes. 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 accidental 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
stoma, which has no nerve endings and is very friable,
and to surrounding skin.
12. Assess stoma and surrounding skin.
13. Measure stoma using measuring guide for appropriate
width and length of stoma at base. Ensures a good fit of
the ostomy appliance without excess skin at the base of
the stoma exposed to stool.
14. Place gauze pad over stoma while preparing the skin
barrier wafer and pouch for application. Wicks stool
away from skin and ensures a good seal of the wafer to
the skin.

FIGURE 23 Infant with ostomy bag.

DOCUMENTATION
1. Pouch change.
2. Condition and color of stoma and skin.
3. How procedure tolerated.
4. Amount and character of stool.

15. Trace pattern of stoma opening onto paper backing of

skin barrier wafer. Ensures better fit and prevents laceration of the stoma or maceration of periostomal skin.
Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.