Ostomy Care

<< DIGESTIVE

Considerations:

  • Ostomy bag should be emptied when 1/3 to 1/2 full or when a leak occurs
  • Ostomy bags are typically changed every 4 days and use should not exceed 7 days
  • Be sure to take steps to ensure patient privacy when performing procedure
  • Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  • “Reading the wafer”: After removing the colostomy bag turn it over the wafer and look at the condition of the barrier.  Consider the stoma like the face of a clock, 12 o’clock being at the top
    • Has the wafer “washed out” at 3 o’clock (near the dip in the skin toward the umbilicus). It may be helpful to put a little extra paste in that area, if ordered, to help avoid leaks

Supplies:

  • Mild soap
  • Water
  • Soft cloth or gauze
  • Skin preparation
  • Protectant powder or paste, if ordered/used
  • Adhesive
  • Adhesive remover, if ordered/used
  • Clean bag
  • Belt, if needed/used
  • Scissors
  • Measuring guide
  • Clean gloves
  • Basin for stool collection (if not near a toilet)
  • Wash clothes, diaper wipes, tissues or paper towels
  • Adhesive tape, if needed
  • Student’s individualized health plan (IHP) and/or healthcare provider’s orders
  • Parent/Guardian authorization form

Travel kit:
The kit should contain:

  • Ostomy pouch/wafer
  • Scissors
  • Tail closure clip, if used
  • Cotton-tipped applicators
  • Gauze or clean cloths
  • Measuring container with pouring spout
  • Mild, pH-balanced soap
  • Paper towel/Washcloth/Wipes
  • Pen to trace the size of the stoma onto the skin barrier
  • Pouch deodorant, if used
  • Scissors to cut the opening
  • Sizing template to measure the size of the stoma opening
  • Skin barrier paste/powder, skin prep, if used
  • Stabilizers, if used
  • Syringes
Procedure Download
Skill Competency Download

Procedure:

  1. Review student’s IHCP and healthcare provider’s order
  2. Ensure proper documentation of parent/guardian authorization to perform this procedure
  3. Assemble equipment and place on a clean surface
  4. Explain the procedure to the student at his/her level of understanding
  5. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  6. Wash hands
  7. If student will be assisting, have student wash hands
  8. Place disposable pad or towel under the student’s ostomy
  9. Put on gloves
  10. Empty contents of pouch before removal (See Emptying Colostomy Pouch)
  11. Measure contents, if ordered
  12. Remove used pouch
    • Remove the outer adhesive by starting at one corner
    • Push down on the skin at each point and pull the barrier away from the skin at the same time
    • If it is painful or difficult to remove the wafer from the skin, use an adhesive remover, if ordered
  13. Tuck gauze into the opening of the pouch that has been removed to help with the odor
  14. Wash the stoma area using warm water and clean gauze or cloth, do not scrub
    • Do not use:
      • Soaps/cleaners with oil or perfume
      • Baby wipes that have oil, moisturizing cream or alcohol
  15. If adhesive remover was used, soap may be needed to remove the oily residue
    • Soaps and baby wipes can leave a residue, be sure to rinse numerous times
  16. Inspect skin for:
    • Redness
    • Irritation
    • Bleeding
    • Blisters
  17. Inspect the stoma for signs of:
    • Bulging
    • Getting longer
    • Darkening in color or turning bluish
  18. Notify parent/guardian, if any abnormalities are observed
  19. Gently pat dry stoma and skin with soft cloth or gauze
    • While a small amount of bleeding with stoma manipulation is normal, continuous bleeding or bleeding from stoma opening is abnormal and must be reported to parent/guardian and healthcare provider
  20. Measure stoma with measuring guide per student specific guidelines
  21. Place absorbent material over stoma to keep irritating drainage off the skin until replacement of pouch
  22. Trace the opening onto the paper backing of the pouch/wafer
  23. Use scissors to cut along the tracing
    • If using a one-piece system, place your finger into the small pre-cut opening and push away the pouch before you start to cut being careful not to cut through the front of the pouch
    • If you cut through the front of the pouch, use a new pouch.  Do not tape it closed.
  24. Center the new opening over the stoma to make sure it fits along the stoma edge.
    • Re-cut and adjust the opening as needed
  25. Smooth any jagged edges with fingers or scissors
  26. Prior to placing on the skin, it may help to “warm” the wafer between your hands to make it easier to conform to the contours of the skin
  27. Remove the paper backing from the pouch barrier
    • Date and keep the paper from the backing to use as your next template
  28. Securely apply pouch closure to bottom of pouch
  29. If ordered, place skin barrier or protectant around stoma
    • Powder helps to absorb moisture
  30. Remove any gauze/tissue placed over the stoma
  31. Center and apply the pouch skin barrier around the stoma
  32. Check that no part of the stoma is trapped beneath the pouch wafer
  33. With the fingers, press the wafer into place beginning at the stoma and working to the outer edge, and circumferentially around the wafer
  34. Assure that all air bubbles and wrinkles are removed and good contact is achieved with the skin
  35. Place a hand (or hands) over the wafer for 1 to 2 minutes, applying pressure and warming the barrier
    • This enhances the barrier adhesion
    • To enhance adhesion, the child should avoid strenuous movements for 30 minutes following a pouch application
  36. For a two-piece system, apply the pouch to the barrier flange
  37. Dispose of used bag in appropriate receptacle per school policy
    • If pouch has a closure clip, do not discard, it can be reused
  38. Remove gloves
  39. Wash hands
  40. If student assisted in care, have student wash hands
  41. Document assessment, intervention and outcomes in student’s healthcare record
  42. Report any problems or concerns to parents/guardian and healthcare provider

References:

American College of Surgeons. (2015). Step-by-step skills checklist and evaluation. Retrieved June 22, 2023, from https://www.facs.org/media/5nrphcg3/skills_checklist.pdf

Hollister. (2018). Caring for your child with an ostomy. Retrieved June 22, 2023, from https://www.hollister.com/-/media/files/pdfs-for-download/ostomy-care/caring-for-your-child-with-ostomy_923057-0318.ashx

Lynn, P. (2019). Emptying and changing an ostomy appliance. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 297-298).

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 36.1 pouching a colostomy or ileostomy. In Clinical nursing skills and techniques. (10th ed.). (pp. 1049-1055). St. Louis, MO: Elsevier.

Porter, S.M., Page, D., Engholm. H., & Somppi, C. (2019). Students supported by medical technology. In Selekman, J. (Ed.), School nursing, a comprehensive text (3rd ed.) (pp. 721-740). Philadelphia PA.: F.A. Davis Co.

Stetzer, M.N. (2021). Essential ostomy knowledge for nurses: Promoting adaptation in children with new ostomy and their caregivers. Pediatric Nursing, 47(2), 71-78.

University of Wisconsin Hospitals. (2020). Health facts for you. Caring for your child’s ostomy. Retrieved June 23, 2023, from https://patient.uwhealth.org/healthfacts/7652

Wound, Ostomy, and Continence Nurses Society. (n.d.). Pediatric ostomy care. Best practice for clinicians. Retrieved June 22, 2023, from https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/PEDIATRIC_OSTOMY_CARE-_BEST_.pdf

Page last reviewed: February 19, 2025
Page last updated: February 19, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.