Macao Polytechnic University

AE
Bachelor of Science in Nursing
Medical Surgical Nursing I
Academic Year 2022-2023

Changing a fecal ostomy pouch

Preparation
Environment ⚫ Provide privacy for client.
⚫ Raise bed to appropriate position, and lower side rails on the work side of the bed.
Nurse ⚫ Check doctor’s orders and client’s care plan.
⚫ Determine exact supplies client uses and gather equipment.
⚫ Wash hand and wear clean gloves.
⚫ Be aware of own body language indicating disgust or disapproval.
Equipment ⚫ Clean drainable pouch
⚫ Skin barrier (wafer)
⚫ Warm water in basin
⚫ Soft cloth
⚫ Bath towel
⚫ Plastic bag for disposable of old pouch
⚫ Clean gloves
⚫ Measuring guide
⚫ 4x4 Gauze
⚫ Tissue paper
⚫ Scissors
⚫ Deodorant (optional)除臭剂
⚫ Hypoallergenic paper tape (optional)
Client ⚫ Identify the client and check client’s conditions.
⚫ Explain procedure to client.
⚫ Place the client in a comfortable semi-fowler position.

Procedure
1. Place a bath towel over client and fold top linen to clients’ lower legs.
2. Empty old pouch by wearing clean gloves.
3. Remove old pouch as it is pulled backing from skin by pushing against patient’s skin to avoid tearing of
patient’s skin.
4. Discard the old pouch into a plastic bag.
5. Clean client’s skin and stoma gently with warm water and soft cloth
- Use Normal Saline when the wound is fresh with oozing of blood.
6. Dry client’s skin well with a soft cloth.
- Keep tissue paper available if stoma evacuates stool while pouch is off.
7. Observe skin and stoma for any changes in size, ulceration, or color
- A healthy stoma should be red.
8. Measure stoma with a measuring guide (cut pouch about 0.3 cm larger than measurement).
9. Apply skin barrier paste (optional) to peristomal area.
10. Instruct client to “puff” out stomach to smooth the affected skin during placement of the skin barrier.
11. Press the skin barrier adhesive around the stoma to form a seal.
- Do not allow adhesive to wrinkle and check the adhesive ring is wrinkle-free.
12. Instruct client to lie quietly for 3-5 minutes to allow pouch to seal.
13. Close and secure end of pouch with tail closure if it is used.
14. Position client for comfort.
15. Lower clients’ bed and raise side rails, if necessary.

Aftercare
⚫ Put away used equipment.
⚫ Remove gloves and wash hands.
⚫ Document the procedure and record the amount, color, and consistency of stool emptied from pouch;
condition of peri-stomal skin and stoma and incision line; any abnormal discharge.

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