1. Appliance Change

The patient is able to independently change the appliance:

• patient observes stoma

• patient participates with appliance removal

• patient participates with peristomal cleansing

• patient participates with appliance change and application

• sizing of stoma

• tracing pattern onto flange (two-piece) or pouch (one-piece)

• cutting opening

• removal of backing

• application of paste or strip paste (optional)

• application of pouch

• patient empties/rinses pouch independently

• patient applies closure to pouching system independently

Two-Piece System

The following steps are generic and applicable for a two-piece system.

1. Assemble the Necessary Supplies

   • Flange and pouch, measuring guide, scissors, pen, strip paste or tube paste (optional), wet/dry cloth, and plastic bag.

2. Remove Flange and Pouch

   • Gently remove the pouching system. Keep one finger against the skin and always remove in the direction of hair growth. Dispose of flange and pouch.

3. Care for the Skin and Stoma

   • Remove any excess stool or mucous with dry gauze. Gently cleanse the stoma and surrounding skin with wet, warm gauze. A mild soap may be used as long as all residue is removed. Pat skin dry. Washing the stoma and skin can be done in the shower.

   • Use a mirror and observe both the stoma and surrounding skin. The skin should always be healthy with no signs of redness or irritation. The stoma should always be pinkish red, moist and smooth.

4. Measure the Stoma

   • For the first six weeks following surgery, the stoma should be measured and the flange opening adjusted accordingly. It is important that there be a small amount of space (1 1/8”) between the cut opening and stoma. This allows room for the stoma to expand and pass stool through the opening. After six weeks, measurement is generally not required and flanges may be pre-cut in advance.

5. Prepare the Flange

   • The flange should be warmed prior to application. This can be done by placing the flange between your hands for a few minutes or sitting on it during preparation.

   • Trace the pattern of the stoma shape onto the back of the flange.

   • Cut the flange to match the pattern.

   • Remove the clear plastic backing from the flange and set the flange aside.

   • Apply the strip paste or tube paste around the cut opening of the flange or directly against the skin around the stoma.

6. Apply the Flange

   • Centre the opening over the stoma and apply the flange against the skin. A mirror may be used to help centre the flange.

7. Apply the Pouch

   • Place the pouch onto the base ring of the flange.

   • Start from the bottom and gently work the pouch onto the flange.

   • Slide the lock into the position that is most comfortable and snap it in place (if using system with a lock device).

   • Gently pull the pouch to ensure the pouch is secure and in place.

8. Close the End of the Pouch

   • If using velcro closure, fold the pouch three times towards you and fold the tabs over the velcro.

   • If using a closure clip, fold pouch once over the clip and secure in place.

9. Remove the Pouch

   • Press the centre of the lock to release (if using system with lock device).

   • Grasp the pouch at the top and gently pull downward.

General Guidelines

• Empty the pouch when its 1/3 to 1/2 full of stool or gas. Always ensure the "tail" portion of the pouch is kept clean and dry following emptying of the pouch.

• Change the pouch at your discretion

• Change the complete system every 5-7 days.

• Change the complete system if visible signs of leakage or if you experience a burning or itchy sensation.

• Notify your Enterostomal Therapy nurse of any concerns or questions.

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