Ostomy Bag and Appliance; Emptying and Changing
For emptying the pouch:
- bedpan, graduated container, and access to a toilet
For changing an appliance:
- ostomy appliance and bag (1 or 2 piece system)
Emptying an ostomy pouch:
- Confirm the patient’s ID using two identifiers.
- Close the curtain to provide patient privacy.
- Perform hand hygiene and don clean gloves.
- Help the patient to a sitting position, if possible, to make it easier for them to assist and to watch the procedure. The patient may choose to sit in the bathroom.
- Place the bedpan or graduated container (for measuring output) under the pouch and remove the clamp. “Cuff” the bottom two inches, turning the end of the pouch inside out, and allow the contents to empty into the bedpan, container, or directly into the toilet. It may be necessary to squeeze the pouch if the feces is more formed.
- Wipe the cuffed end of the pouch with toilet tissue and un-cuff it. Squeeze the air out and reapply the clamp.
- If appliance is not to be changed, remove gloves and perform hand hygiene.
Changing an ostomy appliance:
- Confirm the patient’s ID using two identifiers if not already done.
- Set up a work area over a waterproof pad with a basin and warm water the other supplies including a trash bag.
- Perform hand hygiene and don gloves.
- Place a waterproof pad or towel over the patient’s lap.
- Empty the pouch if not already done.
- Starting at the top and moving around edge, push the skin away from the appliance gently but firmly. Don’t peel the appliance up, which can cause skin tears. Use adhesive remover or warm water if necessary. Discard the appliance or set aside to wash, if reusable.
- Use tissue or gauze to remove any stool from the stoma, and then cover the stoma with gauze. Clean the surrounding skin gently with a washcloth using mild soap and water. Use adhesive remover, if necessary. Do not apply lotion.
- Pat the skin dry and apply skin protectant to the area, but no closer than two inches from the stoma edge. Let it dry completely for 30 seconds.
- Remove the gauze from the stoma and use the stoma measuring guide. The guide will have several holes with which to match the size of the stoma. Then replace the gauze and trace the correct size on the back of the new appliance.
- Using scissors, cut a hole in the appliance that is 1/8 inch larger than the selected stoma size.
- Peel away the backing from the appliance, remove the gauze from the stoma, and carefully lay the new appliance over the stoma, lining up the opening. Smooth out any trapped air and maintain even pressure to the appliance for five minutes.
- Apply the clamp to the bottom of the new pouch.