The basics of changing a pouching system

Urostomy

Your stoma will always be producing urine. This is because your kidneys work constantly. Having all of the pieces of your pouching system ready to apply will make it easier to apply your pouch “between the raindrops”, so to speak. Many people find it convenient to change in the morning, before having anything to drink.

Colostomy

The best time to change is when your stoma is quiet. You may have a bowel movement once a day, or a small amount several times throughout the day. You will come to know the best time for you to change as you learn the routine of your bowel.

Ileostomy

It is easiest to change your pouching system when your stoma is quiet. Sometimes this is first thing in the morning, before you have breakfast or coffee or tea. Eating food will cause contractions of the digestive system from top to bottom, which will increase the amount of output.

Coffee and tea contain compounds that irritate the bowel and make output liquid. The more formed your output, the easier it is to manage while changing.

If you may have a very active stoma while trying to change your pouching system sometimes it’s best to just let it run and apply your pouching system when it is quiet for a moment. Another strategy is to use fast-acting loperamide (Imodium) to slow the output enough to apply a pouching system.

Although there are many manufacturers of ostomy pouching systems, a basic change follows the same steps. You might use other pieces (called accessories) in your pouching system that are not listed here. You should continue to use the accessories that your Nurse Specialized in Wound, Ostomy & Continence (NSWOC) recommends.

A couple of tips before you get started

Take off the whole pouching system as one piece, regardless of whether you use a one-piece or two-piece system – this makes it cleaner and easier.

Don’t forget to breathe! Keep exhaling. It’s normal to be anxious at first. Each time you change your pouch it gets easier.

Changing an ostomy pouching system

  1. Get all of your supplies ready before you take off your pouch.

    • Make sure the pouch is closed.
    • If you use a ring or gasket, get it ready and set it aside.
    • Cut the opening if you are using a cut-to-fit flange.
    • Remove the backing from the flange (skin barrier).
    • Collect your cleaning cloths and drying cloths.
    • Some people use a plastic bag tucked into their waist-band to protect their clothes and act as a garbage.

  2. Gently remove the flange or skin barrier from the skin.

    • Peel back the edge of the flange. Hold the flange steady and use your other hand to press the skin in, away from the flange. This reduces the pulling on the skin.
    • Some people use adhesive remover sprays or wipes to release the seal on the skin more easily. These are not essential but can make it more comfortable to remove the flange.

  3. Use an adhesive remover wipe to remove any sticky residue from the flange or ring (also called a seal or gasket).

  4. Use warm water on a clean cloth or paper towel to wash the skin under the flange.

    • This skin may not be getting washed when you shower, so clean the whole area under the flange.
    • Don’t worry too much about cleaning the stoma itself. The stoma is made of tissue specifically designed to be in contact with stool. The less you touch the stoma the less likely it is to be active while you are changing.
    • Some people like to have a bath or shower with their pouching system off. This is safe for your stoma. Just remember that if you use a two piece system, the whole system must be attached or detached in the shower or bath. Do no shower or bath with the flange attached but no pouch.

  5. Pat your skin dry with a high quality paper towel or lint-free cloth.

  6. Pull the skin above your stoma taut. Do this by placing your finger about 1cm (half-inch) above your stoma and pull the skin up.

    • This centres the opening (called the “os”) of the stoma.
    • This also flattens the abdomen around the stoma to improve the seal.
    • Keep this upward tension on the skin until the flange (skin barrier) is stuck.

  7. Apply the ring or gasket (if you use one) to the skin around the stoma while keeping the upward tension on the skin.

  8. Apply the flange to the skin.

    Make sure that the opening of the flange does not touch or sit on top of the stoma. This is because the stoma is moist and if the flange is sitting on top of it, it will be like sticking tape to your tongue. It will not make a good seal, leading to leakage and skin irritation.

  9. Apply the pouch if you use a two-piece pouching system.

  10. Use one finger to apply gentle pressure around your stoma to help the flange adhere to your skin.

  11. Apply the belt if you use a belt.

  12. Great work! Take a breath and congratulate yourself!

Questions about changes:

Q: Do I need to use any soap or special cleansers on my skin?

A: Less is more. Soaps can leave residues that can cause irritation under the flange. They can also change the pH of the skin, which is an important part of keeping skin healthy. Some soaps have moisturizers that can make it hard for your pouching system to stick well. Medical cleansers aren’t necessary either. Just use water.

Q: Why doesn’t the basic change say anything about powder or skin barrier films (Skin Prep, Cavilon, etc.)?

A: Powder is used like a sponge – it soaks up extra moisture from damaged skin. It is not used when skin is healthy and clear. In fact, powder on the skin makes it harder for your flange to stick. It’s like trying to stick tape to sawdust. The seal will not be successful.

Skin barrier films are only used to create a smooth layer over powder. It is not something needed with each change. Putting a film barrier on the skin will make the skin smooth by filling in all of the pores and folds. The flanges are designed to grab on to your skin by melting into the microscopic pores and folds in your skin. Skin barrier films make it harder to get a good seal.

Q: What kind of paper towel should I use?

A: We recommend a high quality paper towel like Bounty. This is because it doesn’t leave a papery residue on your skin. Toilet paper is not recommended for cleaning or drying your skin.

Q: Do I need to heat up my flange to help it stick?

A: Flanges do not need to be warmed up before application. The heat of your body will start to make your flange adhere right away. If you like, you can put a hand over it for 30 seconds, but you do not have to. You do not need to hold a warm blanket over it, you do not need to use a heating pad, and you do not need to take more than 30 seconds to get it to stick.

If you find you are not getting a good seal, your flange may not be an ideal fit for your body, or you may have a residue of some sort on your skin interfering with your seal.

Q: Do I need to press my flange on firmly to get a good seal?

A: The only pressure we recommend is applying a light pressure around your stoma to get the flange and ring and skin to come together. More pressure will not make a better seal.

Q: Do I need to be still for a half-hour to get my pouch to make a good seal?

A: Your flange will start to stick right away. You do not need to put your life on hold after changing your pouching system. If you’d like to take a rest, go ahead, but don’t do it on account of your stoma.

Q: Can I use baby wipes, either at home, or in my emergency kit, for cleaning my skin?

A: Wipes are not recommended. They contain chemicals that will not be washed off. It is hard to know how they will affect the skin when they are sealed in by the flange. Wipes also can contain moisturizers that will interfere with your seal. A better option is to keep a ziploc bag of dry paper towels you can moisten at the sink.

 

Here is another guide for a basic change:

www.veganostomy.ca