Purpose

• An ostomy is a surgically created opening for the elimination of body wastes. The opening seen through the abdominal wall is called a stoma.
  • A colostomy is an ostomy between the colon and abdominal wall.
  • An ileostomy is an ostomy between the ileum (small intestine) and the abdominal wall.
• The person wears a pouch (bag) over the stoma to collect stools and flatus.
• The pouch has an adhesive backing that is applied to the skin. Some pouches are secured to ostomy belts.
• Pouches have a drain at the bottom that closes with a clamp, clip, or wire closure. The drain is opened to empty the pouch. The pouch is emptied when stools are present. It is opened when it balloons or bulges with flatus. The drain is wiped with toilet tissue before it is closed.
• The pouch is changed every 3 to 7 days and when it leaks. This lets you provide skin care around the stoma. However, frequent pouch changes can damage the skin.
• Odors are prevented by:
  • Performing good hygiene.
  • Emptying the pouch.
  • Avoiding gas-forming foods.
  • Putting deodorant into the pouch. The nurse tells you what to use.

Equipment

Roll cursor over items to see labels. For the purposes of clearly depicting the equipment, a barrier is not shown in this photo. When providing care, a barrier should always be placed on the surface before placing the equipment.

Wash basin with warm water

Bath blanket

Towel

Gauze pads or washcloths

Gloves

Clean ostomy belt, if used

Clean pouch with skin barrrier

Pouch clamp, clip or wire closure

Skin paste (optional)

Pouch deodorant

Adhesive remover wipes

Bedpan with cover

Waterproof pad

Disposable trash bag

Paper towels

Delegation

• Before changing an ostomy pouch, make sure that:
  • Your state allows you to perform the procedure.
  • The procedure is in your job description.
  • You have the necessary education and training.
  • You review the procedure with a nurse.
  • A nurse is available to answer questions and to supervise you.
• Follow delegation guidelines. Before changing an ostomy pouch, obtain this information from the nurse and care plan:
  • If the person has a colostomy or ileostomy
  • When to change the pouch
  • What equipment and supplies to use
  • What soap or cleaning agent to use
  • Drying time for the skin barrier (usually 1 to 2 minutes)
  • What pouch deodorant to use
  • What observations to report and record
  • When to report observations
  • What patient or resident concerns to report at once

Preparation

• Observe quality-of-life measures.
• Review the information under Delegation and Safety and Comfort.
• Practice hand hygiene.
• Collect the equipment.
  
• Place the paper towels on the overbed table. Arrange supplies on top of the paper towels.
• Practice hand hygiene.
• Identify the person. Check the ID bracelet against the assignment sheet. Also call the person by name.
• Put on gloves.
• Collect the remaining equipment on the list.
• Remove and discard the gloves. Practice hand hygiene. Put on clean gloves.
• Provide for privacy.
• Raise the bed for body mechanics. Bed rails are up if used.

Safety

• When changing an ostomy pouch, contact with stools and the stoma is likely. Stools contain microbes and may contain blood. The stoma may bleed slightly when washed. Follow Standard Precautions and the Bloodborne Pathogen Standard.

Comfort

• The stoma does not have sensation. Touching the stoma does not cause pain or discomfort.

Follow-up Care

• Provide for comfort.
• Place the call light within reach.
• Lower the bed to its lowest position. Raise or lower bed rails. Follow the care plan.
• Unscreen the person.
• Practice hand hygiene. Put on gloves.
• Take the bedpan and disposable bag into the bathroom.
• Empty the pouch and bedpan into the toilet. Observe the color, amount, consistency, and odor of stools. Flush the toilet.
• Discard the pouch into the disposable bag. Discard the disposable bag.
• Empty, rinse, clean, and disinfect equipment. Return equipment to its proper place.
• Remove and discard the gloves. Practice hand hygiene.
• Complete a safety check of the room.
• Follow agency policy for dirty linens.
• Practice hand hygiene.

Reporting/Recording

• Report and record your observations, including:
  • Signs of skin breakdown (The normal stoma is red like a mucous membrane.)
  • Color, amount, consistency, and odor of stools
  • Complaints of pain or discomfort