Equipment:

skin barrier (stomahesive, hollihesive, karaya paste)

Procedure:
STEPS RATIONALE
1. Explain procedure (if client is unfamiliar Promotes cooperation and boost confidence in
with technique). Allow client to organize ability to perform procedure.
steps for pouch change. Be sure client
observes procedure.
2. Close room curtains and doors. Provides privacy
3. Place protective pad under the client’s Protects bed from soiling
hip on the side of the stoma.
4. Assist client to a semi-lateral position, Position the client and position the pouch
with the stoma and pouch position downward so it will drain with gravity
downward the bed surface.
5. Wash hands and wear gloves. Reduces transmission of infection
6. Fill large syringe (bulb or 50 cc) with Prepare for later use
warm water. Place in small basin next to
the bedside.
7. Remove the soiled pouch by gently Reduces trauma to the peristomal skin; jerking
pressing on the skin while pulling the can cause skin tears
pouch.
8. Dispose the soiled pouch in the plastic Avoid odors lingering the room which is
bag and tie to seal odor. unpleasant to client or staff
9. Using forceps and cotton balls, wash Removes fecal material and pathogens and
skin gently with mild soap and water or prepares the skin for pouch reapplication.
with NSS to remove secretions from the Secretion acts as irritant to skin. Bacteria in fecal
skin. secretions can enter incisional area/new
colostomy and cause infection.
10. Rinse soap off thoroughly. Blot dry. Use of any soap could result in film or residue
being left behind. This soap residue can result in
chemical reactions or burns and can cause
premature leakage because of interference with
pouch adhesions. Pat dry gently to avoid
trauma.
11. Inspect the peristomal skin for redness, Peristomal skin condition cause morbidity and
 altered skin integrity or rashes, consult if problem with pouch application unless managed
lessions of the peristomal skin are properly.
observed.
12. Prepare ostomy pouch. Cut hole in Avoid risk cut of stoma and ensures better seal
center of faceplate 1/8 inch larger than with barrier.
hole in barrier.
13. Apply skin sealant or skin paste it Promotes an effective seal and protects the
indicated. Apply skin barrier. peristomal skin
14. Remove paper backing from pouch Reduces risks of wrinkling that can occur if
faceplate and apply gently. water is applied to skin before pouch is
attached; gives better leak-proof seal.
15. Press into place for 1-3 minutes while Creates wrinkle-free secure seal onto skin
smoothing out creases or wrinkles.
16. Removes gloves and discard. Wash Reduces risks of transfer of microorganisms
hands.
17. Assist client to comfortable position if Ensure risks if transfer of microorganisms
necessary.
18. Dispose of used equipment according to Proper disposal of equipment prevent
agency policy. contamination from microorganism
19. Note type and size of pouch, condition Document client status and condition of stoma.
of stoma, drainage amount, odor and
surrounding skin, as well as client
response.

Nursing consideration:
1. Explain procedures (if client is unfamiliar with technique) or allow client to organize steps for
pouch change. Be sure clients observe procedure.
2. Select optimal time to change pouch (when client is comfortable between meals or before
administration of medications that may affect bowel function).
3. Collect appropriate equipment.
4. Close room curtain or doors. Provide privacy.
5. Many different types of pouches/ appliances are available; the nurse should always read
manufacturer’s instructions or check with the enterostomal therapist before handling
unfamiliar equipment.
6. Flatus may cause a pouch to balloon out. This requires immediate attention because if flatus is
not released, the pouch may separates from the skin barrier, causing seepage of fecal
contents or release of fecal odor. Open the clamp and released the flatus. Never puncture a
hole in the pouch/ appliance.
7. A one-piece appliance make application easier for an older patient, particularly if impaired
vision or compromised mobility from arthritis is present.

Evaluation:
1. Demonstrate knowledge and positive attitude towards colostomy care.
2. Colon empty of its contents such as feces, gas and mucus.
3. Patients is free from odor.
4. Demonstrate pouch changing and healthy skin around stoma.
5. Client copes with changed body image, manages care of stoma.