Ostomy Care

<< DIGESTIVE


Considerations:

  • Ostomy bag should be emptied when 1/3 to ½ 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

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
  • Stabilizers, if used
  • Syringes
  • Wipes

 procedure download skill competency
  1. Assemble equipment and place on a clean surface
  2. Explain the procedure to the student at his/her level of understanding
  3. Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  4. Wash hands
  5. If student will be assisting, have student wash hands
  6. Put on gloves
  7. Empty contents of bag before removal (See Emptying Colostomy Pouch)
  8. Measure contents, if ordered
  9. Remove used bag
    • Push the skin away from the bag, instead of pulling the bag off the skin
    • If it is painful or difficult to remove the wafer from the skin, use an adhesive remover, if ordered
    • Tuck gauze into the opening of the pouch that has been removed to help with the odor
  10. Wash the stoma area using soap and warm water and clean gauze or cloth, do not scrub
  11. 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
  12. Inspect skin for:
    • Redness
    • Irritation
    • Bleeding
    • Blisters
  13. Inspect the stoma for signs of:
    • Bulging
    • Getting longer
    • Darkening in color or turning bluish
  14. Notify parent/guardian, if observed
  15. Gently pat dry stoma and skin with soft cloth or gauze.
  16. Place absorbent material over stoma to keep irritating drainage off the skin until replacement of pouch
  17. Measure stoma with measuring guide per student specific guidelines
  18. Trace the opening onto the paper backing of the pouch/wafer
  19. 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.
  20. Smooth any jagged edges with fingers or scissors remove the white paper backing from the skin barrier
    • It may help to “warm” the wafer between your hands to make it easier to conform to the contours of the skin
  21. Securely apply pouch closure to bottom of pouch
  22. If ordered, place skin barrier or protectant around stoma
    • Powder helps to absorb moisture
  23. Peel off backing from adhesive
  24. Check to make sure skin remains clean and dry
  25. Apply adhesive to bag or remove backing from adhesive
  26. If ordered, apply stoma adhesive paste to the back of the skin barrier at the edge of the cut opening and set aside for one minute
  27. Center new pouch over stoma
  28. Press bag firmly against skin barrier for 30 seconds to create seal between body and wafer/pouch, to prevent leaks; avoid creating wrinkles
  29. Dispose of used bag in appropriate receptacle per school policy
    • If pouch has a closure clip, do not discard, it can be reused
  30. Remove gloves
  31. Wash hands
  32. If student assisted in care, have student wash hands
  33. Document assessment, intervention and outcomes in student’s healthcare record
  34. Report any problems or concerns to parents/guardian and healthcare provider

Resources:

ConvaTec:  Video Library

ConvaTec: Ostomy basics

Hollister: Caring for your child with an ostomy


References:

American College of Surgeons.  (2012).  Ostomy Skills: Emptying and Changing the Pouch.  Available at: http://www.facs.org/patienteducation/skills/empty-pouch.pdf

Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Clark, J.  (2005).  Solving Pediatric Pouching Problems.  OQ, 42(4), 42-3.

Children’s Hospitals and Clinics of Minnesota.  (2011).  A Guide for Parents G-tube: Care at Home.  Available at: http://www.childrensmn.org/manuals/pfs/homecare/196854.pdf

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

Gray, E.H., Blackinton, J. and White, G.M. (2006).  Stoma Care in the School Setting.  The Journal of School Nursing, 22, 74.

Porter, S., Haynie, M.D., Bierle, T., Caldwell, T. & Palfrey, J.  (1997).  Children and Youth Assisted by Medical Technology in Educational Settings.  Guidelines for Care.  Second Edition.  Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624.

West Virginia Office of Healthy Schools Division of Educator Quality and System.  (2010).  Support Basic and Specialized Health Care Procedures Manual for West Virginia Public Schools.

Wound, Ostomy, and Continence Nurses Society (WOCN).  (2010).  Management of the patient with a fecal ostomy: best practice guideline for clinicians. Available at: http://guideline.gov/content.aspx?id=23869&search=stoma


Acknowledgment of Reviewers:

Lori A. Duesing, MSN, RN, CPNP-AC
Advanced Practice Nurse
Department of Gastroenterology
Children’s Hospital of Wisconsin

Kathy Leack, MS, RN, CNS
Advanced Practice Nurse
Children’s Hospital of Wisconsin


Page last updated: April 7, 2015