Ostomy Appliance Change
Key Points
- Include patient preferences/home routine in pouch-change planning.
- Clean stoma/peristomal skin with water, dry well, and reassess before applying new barrier.
- Wafer opening should fit closely (commonly no more than about 2 mm exposed skin).
- Secure downward pouch orientation and clamp closure to prevent leakage.
Equipment
- Warm water, washcloth/gauze, absorbent pads/chux
- Ordered/preferred ostomy products (wafer, pouch, clamp/closure)
- Sizing guide, marker/pen, scissors
- Optional skin prep/barrier products per plan
- Gloves and waste receptacle
Procedure Steps
- Verify patient identity, explain process, and review patient home-care preferences.
- Position patient for safe access (bathroom or bed with abdomen exposure only) and protect linens.
- Don gloves, empty and remove current pouch, and assess output characteristics.
- Remove adhesive residue gently from peristomal skin.
- Clean stoma and surrounding skin with gauze/water, then pat dry.
- Assess stoma color/moisture and peristomal skin integrity before reapplication.
- Cover stoma with gauze while preparing new appliance.
- Trace/cut wafer opening to fit stoma (target about ⇐2 mm exposed peristomal skin).
- Apply optional skin prep and allow tacky dry time.
- Center wafer over stoma, press to seal, attach pouch with downward opening, and close clamp.
- Dispose supplies, remove gloves, perform hand hygiene, and document findings/concerns.
Fit Error Risk
Excess exposed skin around stoma increases leakage and skin-injury risk.
Documentation Requirements
- Appliance type used and fit status.
- Stoma/peristomal assessment findings.
- Output appearance and quantity context if relevant.
- Patient tolerance, questions, teaching, and preference-based adjustments.
Related
- colostomy-care - Stoma assessment and long-term management context.
- urostomy-care-and-complication-surveillance - Urinary diversion considerations that modify pouching routines.