Changing your pouching system

When and how to change your pouching system.

WHEN TO CHANGE

UROSTOMY
Your stoma will consistently be producing urine. This is because your kidneys work constantly. Having all of the pieces of your pouching system ready will make it easier to apply your pouch “between the raindrops,” so to speak. Many people find it convenient to change before having anything to drink in the morning.
COLOSTOMY
The best time to change is when your stoma is quiet. You may have a bowel movement once a day or a small amount several times throughout the day. You will come to know the best time for you to change as you learn your bowel routine.
ILEOSTOMY

It is easiest to change your pouching system when your stoma is quiet. Sometimes this is first thing in the morning before breakfast, coffee or tea. Eating food will cause contractions of the digestive system from top to bottom, which will increase the amount of output. Coffee and tea contain compounds that irritate the bowel and make output liquid. The more formed your output, the easier it is to manage while changing.

If you may have a very active stoma while trying to change your pouching system, sometimes it’s best just to let it run and apply your pouching system when it is quiet for a moment. Another strategy is to use fast-acting loperamide (Imodium) to slow the output enough to apply a pouching system.

HOW TO CHANGE

Although there are many manufacturers of ostomy pouching systems, a basic change follows the same steps. You might use other pieces (called accessories) in your pouching system that are not listed here. It would be best if you continue to use the accessories that your NSWOC recommends.

BEFORE YOU GET STARTED

  • Take off the whole pouching system as one piece, regardless of whether you use a one-piece or two-piece system – this makes it cleaner and more manageable.
  • Don’t forget to breathe! Keep exhaling. It’s normal to be anxious and know that each time you change it gets easier.
  • Get all of your supplies ready before you take off your pouch.
    • Make sure the pouch is closed.
    • If you use a ring or gasket, get it ready and set it aside.
    • Cut the opening if you are using a cut-to-fit flange.
    • Remove the backing from the flange (skin barrier).
    • Collect your cleaning cloths and drying cloths.
    • Some people use a plastic bag tucked into their waistband to protect their clothes and act as a garbage.

Steps

1.

Gently remove the flange or skin barrier from the skin.

  • Peel back the edge of the flange. Hold the flange steady and use your other hand to press the skin in, away from the flange. This reduces the pulling on the skin.
  • Some people use adhesive remover sprays or wipes to release the seal on the skin. These are not essential but can make it more comfortable to remove the flange.

2.

Use an adhesive remover wipe to remove any sticky residue from the flange or ring (also called a seal or gasket).

3.

Use warm water on a clean cloth or paper towel to wash the skin under the flange.

  • This skin may not be getting washed when you shower, so clean the whole area under the flange.
  • Don’t worry too much about cleaning the stoma itself. The stoma is made of tissue specifically designed to contact stool. The less you touch the stoma, the less likely it is to be active while changing.
  • Some people like to have a bath or shower with their pouching system off. This is safe for your stoma. Just remember that if you use a two-piece system, the whole system must be attached or detached in the shower or bath. Do not shower or bath with the flange attached but no pouch.

4.

Pat your skin dry with a high-quality paper towel or lint-free cloth.

5.

Pull the skin above your stoma taut. Do this by placing your finger about 1cm (half-inch) above your stoma and pull the skin up.

  • This centres the stoma’s opening (called the “os”).
  • This also flattens the abdomen around the stoma to improve the seal.
  • Keep this upward tension on the skin until the flange (skin barrier) is stuck.

6.

Apply the ring or gasket (if you use one) to the skin around the stoma while keeping the upward tension on the skin.

7.

Apply the flange to the skin.

  • Make sure that the opening of the flange does not touch or sit on top of the stoma. This is because the stoma is moist, and if the flange is seated on top of it, it will be like sticking tape to your tongue. It will not make a good seal, leading to leakage and skin irritation.

8.

Apply the pouch if you use a two-piece pouching system.

9.

Use one finger to apply gentle pressure around your stoma to help the flange adhere to your skin.

10.

Apply the belt if you use a belt.

11.

Great work! Take a breath and congratulate yourself!

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