Changing the Appliance

The following steps are for a two-piece system appliance change and are generic. All ostomy companies provide directions for their specific product on the packaging.

Gather All Your Supplies
If using a two-piece system you will require:

• Flange and pouch

• Closure clip if applicable

• Paste (tube or strip) if applicable

• Measuring guide (your stoma will need to be measured and the pattern adjusted for the first 6 weeks following surgery)

• Pen, scissors, mirror

• Wet/dry cloths

• Bag to dispose of soiled appliance

Appliance Removal

• Many people with ostomies find it quite convenient to change their appliance in the shower during a quiet time. Over time, most individuals will sense quiet times and active times.

• Appliance changes should be planned, regular events, rather than emergency responses to problems.

• Remove the appliance with care. Keep one finger against the skin as you lift the flange — roll/push motion. Many people find removing the appliance in the shower under running water facilitates removal of the appliance.

• Dispose of appliance. Save closure clip if applicable.

Stoma and Peristomal Cleansing

• With a dry cloth, remove excess stool and mucous from stoma.

• Cleanse the stoma and peristomal skin with warm tap water. Scant bleeding on the cloth would be normal. The stoma is lined with blood vessels which may bleed when cleansing.

• Excess peristomal hair may be removed with scissors or electric razor. Any peristomal hair should be removed about every 2 to 3 appliance changes. This prevents irritating the hair follicles. An electric razor is the best method to remove hair. The stoma can be protected by using an old toilet paper roll.

Observe the Stoma and Peristomal Skin

• Using a mirror, observe the stoma and peristomal skin. The skin should always be healthy and free of any signs of redness or irritation. The stoma should always be red in colour, moist and smooth.

• The stoma should be measured for the first six weeks following surgery. The opening to the appliance should be 1/8 inch larger (3 to 4 mm) than the base of the stoma itself.

Prepare the Flange

• Trace and cut the opening of the stoma on the back of the flange.

• Remove backing paper.

• Apply a bead of paste (if applicable) around the opening only. The paste does not need to be spread or smoothed in place.

Centre the Flange

• Stand in front of mirror to help center the flange over the stoma.

• Avoid skin wrinkles underneath. Pushing or stretching your abdomen will help to avoid wrinkles.

Attach the Pouch

• Fit the pouch to the ring of the flange. Start from the bottom and walk the pouch up and over. An audible clip is often heard.

• If using a system with a lock — click in place.

• Gently tug downward on the pouch to ensure the pouch is securely in place.

• Add deodorant drops if needed.

• Apply closure through the use of a clip or velcro.

• Hold hand over the appliance for 2 to 3 minutes to encourage adhesion to the skin.

To Empty Pouch

• Empty pouch when it is one-third to one-half full.

• Sit directly on toilet.

• Place tissue in the toilet bowel to avoid splashing.

• If using closure clip, remove and place in a safe area. “Cuff” the tail portion of the pouch. If using velcro closure, undue it and open tail portion of the pouch.

• Slowly empty the contents into the toilet bowel. The pouch may need to be “milked”.

• A rinse bottle filled with warm water may be used to gently flush the inside of the pouch. This is not a necessary step.

• Wipe the inside and outside of the tail portion of the pouch.

• Add deodorant drops as necessary.

• Reapply closure clip or velcro.

Special ConsiderationsFor Individuals with an IleostomyAs the stool from an ileostomy tends to be more irritating than that of a colostomy, protection of the skin is very important. Protruding or raised stomas are ideal and help to facilitate protection of the skin. The type of barrier selected can also help to protect the skin as some barriers are more resistant to the effects of the stool and can be worn for longer periods of time (up to a week) without damage or irritation. These barriers are known as extended wear barriers. Regular wear barriers tend to "melt" or wash away more quickly with stool from an ileostomy, and so more frequent changes are required (about every four days).

Pouches for ileostomies tend to be drainable or open-ended. This means that the stool would be drained or emptied into the toilet through the tail portion of the pouch. The tail portion is closed either with a closure clip or a velcro style closure.

For Individuals with a ColostomyThe stool from a colostomy tends to be less irritating to the skin, and because it is usually formed it tends not to undermine the appliance. As a result, stomas for colostomies can be somewhat flush. Again, because the stool tends to be formed, the barrier will not melt or wash away as quickly and so regular wear barriers are usually sufficient to provide a seal. Initially, you may want to change the flange every four to five days, but as the stool becomes more formed and regulated, you may find that the wear-time can be stretched to six to seven days.

Pouches for colostomies can be either drainable (open-ended) or closed-end. Closed-ended pouches are generally discarded when half full of stool. You can discuss options with your ET to see which will best suit your needs and lifestyle. Colostomy pouches may also have the option of a gas filter which will allow the gas to pass out of the pouch deodorized by a charcoal filter. It will not prevent the sound of gas from escaping into the pouch. Using pouches with a gas filter is best when the stool is formed, as liquid stool tends to clog the filter and render it ineffective.