Pouching Urinary System of Artificial Bladder Channel–Removal and Application of New Pouch

Considerations:

  • Be sure to take steps to ensure student privacy when performing procedure
  • Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills
  • There may be a small amount of urine leakage through the artificial opening
  • The school nurse should be aware of the student’s baseline urine characteristics to identify any concerning changes that may need intervention

Supplies:

  • Gloves
  • Catheter storage bag
  • Disposable wipes or soap and water
  • Urinal or receptacle for urine if procedure is not performed on the toilet
  • Water based lubricant
  • New urostomy pouch, if needed
  • Washcloth
  • Towel or disposable pad to place under student if procedure is done on a cot/bed
  • Student’s Individualized Healthcare Plan (IHP) and health care provider’s order
  • Parent/Guardian authorization form
Procedure Download
Skill Competency Download

Procedure for Pouching System Removal and Application:

  1. Review IHP and health care provider’s order
  2. Ensure proper documentation of parent/guardian authorization to perform this procedure
  3. Gather equipment and place on clean surface
  4. Explain the procedure to the student at their level of understanding
  5. Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills
  6. If the student is completing the procedure or assisting in procedure, have student wash hands
  7. Carefully remove the skin barrier, being cautious not to tear the skin
    • To assist in removal, gently push the skin away from the barrier, away from the direction of hair growth
    • Loosen and lift the edge with one hand and press down on the skin near the sticky backing with the other hand
  8. Place old skin barrier in garbage receptacle
  9. Clean around the stoma with warm water and a washcloth or prescribed cleansing material
    • Avoid using baby wipes, oils and lotions, as they will prevent adherence of the new appliance
  10. Spots of blood on student’s cleansing cloth is no cause for alarm. The blood vessels in the surface skin tissue around the stoma are very delicate and are easily disturbed. For this reason, cleaning around the stoma as you change the student’s pouch or skin barrier may cause slight bleeding. The bleeding will usually stop as quickly as it started
    • While a small amount of bleeding with stoma manipulation is normal, continuous bleeding or bleeding from the stoma opening is abnormal and must be reported to parent/guardian and healthcare provider
  11. Dry the skin thoroughly
  12. Keep gauze or a towel handy to manage any urine output
  13. Measure the stoma
  14. Trace the same size opening on the back of the new appliance
  15. Cut opening in pouch
    • Cut or mold the barrier as necessary, making the opening just large enough to fit around the stoma
      • Cut the opening no more than ⅛ inch larger than the stoma
    • Do not leave exposed skin around the stoma
    • Prior to placing on the skin, it may help to “warm” the wafer (also known as a flange or baseplate) between your hands to make it easier to conform to the contours of the skin
    • Most barriers adhere better when warm
  16. Remove protective backing from adhesive backing or wafer surface
    • Date and keep the paper from the backing to use as your next template
  17. Place the skin barrier (if using a two-piece system) or place the one-piece system over student’s stoma
  18. Press your fingers firmly across the entire barrier to adhere it to student’s skin
    • Remember to make sure the skin is dry to ensure adherence to the skin
  19. Keep your hand on student’s pouching system for several minutes to ensure it adheres to their abdomen
  20. Dispose of used bag in appropriate receptacle per school policy
    • If pouch has a closure clip, do not discard, it can be reused
  21. Remove gloves
  22. Wash hands
  23. If student assisted in care, have student wash hands
  24. Document assessment, intervention, and outcomes in student’s health care record
  25. Report any problems or concerns to parents/guardian and health care provider

References:

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 36.2 pouching a urostomy. In Clinical nursing skills and techniques. (10th ed.). (pp. 1055-1058). St. Louis, MO: Elsevier.

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 36.3 catheterizing a urinary diversion. In Clinical nursing skills and techniques. (10th ed.). (pp. 1058-1061). St. Louis, MO: Elsevier.

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Promoting complete bladder emptying. In Clinical nursing skills and techniques. (10th ed.). (pp. 1245-1246). St. Louis, MO: Elsevier.

United Ostomy Associations of America, Inc. (UOAA). (2023). Living with a urostomy. Retrieved June 21, 2023, from https://www.ostomy.org/wp-content/uploads/2023/06/UOAA_Living_with_a_Urostomy_Guide_2023-01b.pdf

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

Wound, Ostomy, and Continence Nurses Society®. (2015). Care and management of patients with urinary catheters: A clinical resource guide. Retrieved June 20, 2023, from https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/Care_&_Mgmt_Pts_w_Urinary_Ca.pdf

Wound, Ostomy, and Continence Nurses Society®. (2018). Catheterization of an ileal or colon conduit stoma. Best practice for clinicians. Retrieved June 20, 2023, from https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/Catheterization_of_Urinary_S.pdf

Wound, Ostomy, and Continence Nurses Society®. (2018). Urostomy urine sample collection instruction card. Retrieved June 20, 2023, from https://www.ostomy.org/wp-content/uploads/2021/04/Urostomy-Sample-Instruction-Card-for-Patients-2018.pdf

Page last reviewed: March 3, 2025

Page last updated: March 3, 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