Steps for changing an ostomy bag

[marissab208]

Could anyone please give me a list of supplies needed and basic steps to changing a patient's ostomy bag? Also, what is the best way to educate a patient about how to do this himself?

[annaedRN, RN]

Supplies needed - 4x4s/washrag, NSS or water, scissors, ostomy appliance (wafer and bag - 1 or 2 piece system), skin barrier wipes, stomahesive powder, possibly eakins seal or paste.

What I am going to describe is for a patient with a regular stoma ( not retracted, or having any mucocutaneous separations, skin problems, etc ). Clean peristomal skin- use NSS, plain water or a soap without any oils (like Ivory) and rinse well, pat dry. Prep the skin by using stomahesive powder or antifungal powder then seal with a skin barrier wipe (preferably non-sting). let dry. Cut the opening in the wafer out so that there is no rubbing on the stoma when applied (about 1/8 inch away from edge of stoma). Place wafer over stoma and attach bag (if 2 piece system). That's it...

BUT....there are a lot of little things that make it really work and achieve a good seal. Having the patient warm up the wafer with their hands/body heat helps the wafer meld to their skin. Once it is on, I always tell patients the job isn't over for another 5-10 minutes...because that's how long they should keep their hands over the wafer and use their fingers to rub/press the edges of the wafer down against skin to help get a good seal. Knowing what shape/size of wafer will work best - with convexity (if stoma is flush or retracted), or an oval shaped wafer...especially if stoma is located in a "fold" or "crease". Knowing how to build up the surrounding skin or problem areas using paste, Eakins, etc. As far as teaching, it is just explaining each step and then having them help with small steps at a time. First cleaning, then cutting out wafer, etc...a little more each time. Teaching them to figure out when the ostomy is the least active and plan changes during that time is helpful. Patient's need to be independent with emptying/changing bag before coming home from hospital...you'd be surprised how many are clueless. Teaching them to empty bag once about 1/2 full so weight in bag won't loosen seal. Having patient "play" with wafer, attaching bag to wafer, closing up end, etc, helps the patient become familiar with the supplies. Hope this helps you - feel free to ask questions or have me explain more if I wasn't clear enough. :) Good luck

[berube]

i also give them written instructions to follow, doing a new step with each home visit.