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

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. 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 pouch before removal (See Emptying Colostomy Pouch)
  8. Measure contents, if ordered
  9. 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
  10. Tuck gauze into the opening of the pouch that has been removed to help with the odor
  11. 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
  12. 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
  13. Inspect skin for:
    • Redness
    • Irritation
    • Bleeding
    • Blisters
  14. Inspect the stoma for signs of:
    • Bulging
    • Getting longer
    • Darkening in color or turning bluish
  15. Notify parent/guardian, if any abnormalities are observed
  16. Gently pat dry stoma and skin with soft cloth or gauze
  17. Place absorbent material over stoma to keep irritating drainage off the skin until replacement of pouch
  18. Measure stoma with measuring guide per student specific guidelines
  19. Trace the opening onto the paper backing of the pouch/wafer
  20. 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.
  21. Center the new opening over the stoma to make sure it fits along the stoma edge. Re-cut and adjust the opening as needed
  22. Smooth any jagged edges with fingers or scissors
  23. 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
  24. Remove the paper backing from the pouch barrier
  25. Securely apply pouch closure to bottom of pouch
  26. If ordered, place skin barrier or protectant around stoma
    • Powder helps to absorb moisture
  27. Remove any gauze/tissue placed over the stoma
    • Date and keep the paper from the backing to use as your next template
  28. Center and apply the pouch skin barrier around the stoma
  29. Check that no part of the stoma is trapped beneath the pouch wafer
  30. With the fingers, press the wafer into place beginning at the stoma and working to the outer edge, and circumferentially around the wafer
  31. Assure that all air bubbles and wrinkles are removed and good contact is achieved with the skin
  32. 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
  33. For a two-piece system, apply the pouch to the barrier flange
  34. Dispose of used bag in appropriate receptacle per school policy
    • If pouch has a closure clip, do not discard, it can be reused
  35. Remove gloves
  36. Wash hands
  37. If student assisted in care, have student wash hands
  38. Document assessment, intervention and outcomes in student’s healthcare record
  39. Report any problems or concerns to parents/guardian and healthcare provider

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.

UW Health. (2020). Caring for your child’s ostomy.  Available at: https://patient.uwhealth.org/healthfacts/7652

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).  (2011).  Pediatric ostomy care: Best practice for clinicians. Available at: https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/PEDIATRIC_OSTOMY_CARE-BEST.pdf

Acknowledgment of Initial 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 reviewed: October 5, 2021
Page last updated: October 5, 2021

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.