11. Remove inner backing on flange. Prepare flange to be placed on stoma.

12. Remove wick from stoma and apply flange The flange is heat activated.
around stoma. Leave the border tape on. Apply
pressure. Hold in place for 1 minute to warm the
flange to meld to patient’s body. Then remove
border backing and attach to patient.

13. Apply the urostomy bag by ensuring the drain
is turned to the “off” position, or connect the
urostomy bag to a drainage bag at the bedside.
This prevents effluent from soiling the patient or
bed.
If drainage bag is used, ensure the bag is hanging
below the urostomy to prevent backflow of urine
into the stoma.

14. Hold palm of hand over pouch for 2 minutes Pouches are heat activated and adhere more
to assist with appliance adhering to skin. effectively when heat is applied.

15. Remove waterproof pad, clean up supplies, This step prevents contamination from equipment
place patient in a comfortable position, and and reduces the transmission of microorganisms.
perform hand hygiene.

Data source: BCIT, 2015b; Perry et al., 2014; Vancouver Coastal Health, 2014b

Special Considerations:

 Teach patients how to change a urostomy bag even if they appear disinterested.
Do not insist that they look at the ostomy; allow them time to adjust.
 Educate patients on the importance of drinking adequate fluids each day (unless
contraindicated) to prevent a UTI. Patients should drink at least 2 litres of fluid per
day (unless contraindicated).
 Some mucous in the urine is normal, but blood is not a normal or expected
finding.
 Educate patients on the signs and symptoms of a UTI, which include fever,
flank (back) pain, cloudy or smelly urine, and feeling of malaise.
 Educate patients on where to buy supplies and which supplies to have on hand
in case the flange leaks and needs replacing (Perry et al., 2014).

Critical Thinking Exercises

1. What dietary or medication changes might be considered for a patient who has a new
ileostomy and no longer has a small bowel?
2. A patient with a new colostomy refuses to look at his stoma or participate in changing the
pouching system. What are some suggestions to help your patient adjust to the stoma?
  Previous: 10.6 Chest Tube Drainage Systems
Next: 10.8 Summary 
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LICENSE

Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie
Anita McCutcheon is licensed under a Creative Commons Attribution 4.0
International License, except where otherwise noted.

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