How often to change colostomy bags???

[CareBayer]

I had some issues finding a clear policy regarding how often a colostomy bag should be changed at my hospital. One (seasoned) nurse said to only change it if needed (i.e. leaking) b/c pulling off and reapplying the adhesive can damage the skin surrounding the stoma. But I worry about being able to clean the stoma....what's your take?

Thanks from a new nurse!!!!

[oldiebutgoodie, RN]

I had some issues finding a clear policy regarding how often a colostomy bag should be changed at my hospital. One (seasoned) nurse said to only change it if needed (i.e. leaking) b/c pulling off and reapplying the adhesive can damage the skin surrounding the stoma. But I worry about being able to clean the stoma....what's your take?

Thanks from a new nurse!!!!

1. ALWAYS change if leaking. That includes if you see leakage under the tape collar, not just leaking all over the bed.

2. Change if patient complains of itching or burning.

3. For new colostomies, it is probably good to change every 4 days, or even more frequently. The stoma will shrink in size over the first 6 to 8 weeks.

4. It really depends on the patient, their skin, whether the pouching surface is flat, soft, hard, puckered. If this is an "old" colostomy, ask the patient.

5. NEVER go longer than 7 days. The backing tends to "melt" around the stoma, causing leakage.

6. You may have to change more often if the patient is febrile. The backing can "melt" due to the higher body temperature.

7. Ileostomies and urostomies may have to be changed more often due to the liquid effluent.

8. So, in other words, it depends, on the patient, the age of the ostomy, where the stoma is, etc.

Good luck,

Oldiebutgoodie

Wound and ostomy RN

[kimmie518]

This reminds me. The mother of one of my peds patients, keeps taking off the appliance, will get a new one, cut a tiny tiny hole out, and put it ON the stoma, with the tiny tiny hole overlying the hole he poo's out of. I've educated her plenty of times, but keeps insisting that's how its supposed to be done. He's starting to bleed :-(. Sorry I digress.

We have an ostomy nurse who comes about every 7 days to change the appliance. But his (above) get's changed every time the mom leaves (lol!).

[TheCommuter, BSN, RN]

Moved to the Wound, Ostomy & Continence forum.

[elizabells, BSN, RN]

This reminds me. The mother of one of my peds patients, keeps taking off the appliance, will get a new one, cut a tiny tiny hole out, and put it ON the stoma, with the tiny tiny hole overlying the hole he poo's out of. I've educated her plenty of times, but keeps insisting that's how its supposed to be done. He's starting to bleed :-(. Sorry I digress.

We have an ostomy nurse who comes about every 7 days to change the appliance. But his (above) get's changed every time the mom leaves (lol!).

Can the ostomy nurse talk to her? Since she won't listen to you?

On our unit we change only as needed for leakage. I've yet to see one go more than about 36h, though, as we tend to have ileostomies (for NEC) rather than colostomies, and as the babies are on formula/EBM, have such liquid stool.

[Bubonic Betty]

Hi, you don't need to clean the stoma on a daily basis. It is made of intestine (and mucous membrane). I don't know what hospital policy is, but to keep skin in tact and healthy, waiting for it to leak before changing it is just asking for skin breakdown.

Exactly what Oldiebutgoodie said!

As far as the peds patient, I don't even understand what she's doing! Why would she purposely make a hole in the pouch? Sounds like she needs some teaching.