Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
COLLEGE OF HEALTH SCIENCES

Name of Student: Date:

Year and Section: Grade:

PROCEDURE CHECKLIST: CHANGING AND EMPTYING OSTOMY

APPLIANCE

ASSESSMENT:
 The type 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, according to the nursing care plan.

PLANNING:

 Review features of the appliance to ensure that all parts are present and functioning
correctly

Assemble equipment:

1. Ostomy Kit (Ostomy Barrier, Ostomy Bag, Ostomy Clamp)

2. Clean gloves
3. Bed pan or container
4. Under pads
5. Tissue or Gauze pad
6. Scissor
7. Basin with warm water
8. Mild Soap
9. Wash cloth and towel

PREPARATION DONE NOT REMARKS

DONE
Gather the necessary equipment.
PROCEDURE
1 Perform hand hygiene and apply non sterile
. gloves.
2 Explain the procedure and purposes to the
. patient
3 Provide privacy. Assist to a comfortable
. sitting or lying position in bed or a standing
or sitting position in the bathroom.
EMPTYING AN OSTOMY APPLIANCE
1 Empty contents into bed pan, container or
. measuring device.
2 Wipe the lower 2 inches of the appliance or
. pouch with toilet tissue or towel.
3 Uncuff the edge of the appliance or pouch
. and apply the clip or clamp.
4 Dispose of used equipment according to
. agency policy.
5 Perform Hand Hygiene.
.
6 Document the following:
. Appearance of stoma,
Condition of peristomal skin,
Characteristics of drainage (amount,
color consistency, unusual odor)
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
COLLEGE OF HEALTH SCIENCES
Patient reaction to procedure.
CHANGING AN OSTOMY APPLIANCE
1 Slowly remove the appliance beginning at
. the top while keeping the abdominal skin
taut.
2 Use toilet tissue to remove any excess stool
. from the stoma.
3 Gently wash and pat dry the peristomal skin.
. Mild Soap may be used to cleanse the
peristomal skin taking care to ensure that all
soap is rinsed before reapplying the pouch
and the barrier.
4 Assess the appearance of the peristomal
. skin and stoma. a moist reddish-pink stoma
is considered normal.
5 Apply 1 piece or 2 piece system:
. a. Select size for stoma opening by
using measurement guide.
b. Trace same size circle on the back
and center the skin barrier.
c. Use scissors to cut an opening ¼ to
1/8 inch larger than the stoma.
d. Remove the backing of protective
skin barrier.
e. Ease barrier and appliance or pouch
onto the abdomen and over the stoma and
gently press onto skin while smoothing out
creases or wrinkles.
6 Dispose of used equipment according to
. agency policy.
7 Perform Hand Hygiene
.
8 Document the ffg:
. Appearance of stoma, condition of
peristomal skin, & patient reaction to
procedure.

Date/Time: ___________________________

Facilitator: ____________________________