Nursing How To’s: Changing and Emptying Ostomy Appliance
Alex is scanning his medical surgical book, trying to look for something interesting to read to pass time when he comes about the topic ostomy care. He instantly becomes intrigued as he sees pictures of patients with different types of ostomies and he wonders how one cares for patient with such. Moreover, he wants to know how a nurse is able to change and empty an ostomy appliance since he knows that it can’t stay that way forever.
With his curiosity getting the best of him, he decides to read more about the topic and even do some research about it from the internet later on, hoping to answer the queries boggling his mind.
Steps on Changing and Emptying Ostomy Appliance
- Gather necessary equipment. Identify the resident. Explain procedure and encourage resident to observe or participate if possible.
- Close curtains around bed and close door to room if possible.
- Perform hand hygiene.
- Assist resident to a comfortable sitting or lying position in bed or a standing or sitting position in the bathroom.
Emptying an Appliance
- Ostomy appliances should be emptied when 1/3 – 1/2 full. Put on disposable gloves. Remove clamp and fold end of pouch upward like a cuff.
- Empty contents into bedpan, toilet, or measuring device. Rinse appliance or pouch with tepid water in a squeeze bottle.
- Wipe the lower 2” of the appliance or pouch with toilet tissue.
- Uncuff edge of appliance or pouch and apply clip or clamp. Remove gloves. If appliance is not to be changed, perform hand hygiene. Assist resident to comfortable position.
Changing an Appliance
- Place a disposable pad on the work surface. Set up the wash basin with warm water and the rest of the supplies. Place a trash bag within reach.
- Put on clean gloves. Place waterproof pad under the resident at the stoma site. Empty the appliance as previously described.
- Gently remove pouch faceplate from skin by pushing skin from appliance rather than pulling appliance from skin. Start at the top of the appliance, while keeping the abdominal skin taut. Push the skin from the appliance rather than pulling the appliance from the skin.
- Place the appliance in the trash bag, if disposable. If reusable, set aside to wash in lukewarm soap and water and allow to air dry after the new appliance is in place.
- Use toilet tissue to remove any excess stool from stoma. Cover stoma with gauze pad. Clean skin around stoma with mild soap and water or a cleansing agent and a washcloth. Remove all old adhesive from skin; an adhesive remover may be used. Do not apply lotion to peristomal area.
- Gently pat area dry. Make sure skin around stoma is thoroughly dry. Assess stoma and condition of surrounding skin.
- Apply skin protectant to a 2” (5-cm) radius around the stoma, and allow it to dry completely, which takes about 30 seconds.
- Lift the gauze squares for a moment and measure the stoma opening, using the measurement guide. Replace the gauze. Trace the same-size opening on the back center of the appliance. Cut the opening 1/8” larger than the stoma size.
- Remove the backing from the appliance. Quickly remove the gauze squares and ease the appliance over the stoma. Gently press onto the skin while smoothing over the surface. Apply gentle pressure to appliance for 5 minutes.
- Close bottom of appliance or pouch by folding the end upward and using clamp or clip that comes with product.
- Remove gloves. Assist the resident to a comfortable position. Cover the resident with bed linens. Place the bed in the lowest position.
- Put on clean gloves. Remove or discard equipment and assess resident’s response to procedure. Remove gloves and perform hand hygiene.
Sources:
Liane Clores, RN MAN
Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.
