EQUIPMENT
Appropriate drainable ostomy appliance (bag and skin bar-

rier wafer)

Skin barriers, e.g., Stomahesive paste and powder
Clean washcloth, 4

× 4 gauze, or cotton balls

Warm tap water
Ostomy soap (if prescribed by agency policy)
Scissors
Pen or pencil
Gloves, nonsterile

PROCEDURE

1. Gather equipment. Promotes organization and effi-

ciency.

2. Explain procedure to child and family. Enhances cooper-

ation and participation and reduces anxiety and fear.

3. Wash hands. Reduces transmission of microorganisms.
4. Assemble pouch according to instructions.
5. Put on nonsterile gloves. Protects nurse from contact

with body fluids.

6. Empty current ostomy pouch of stool. Prevents acciden-

tal contamination of surrounding environment if stool
accidentally leaks from appliance when removed.

7. Remove current ostomy appliance.
8. Dispose of appliance in appropriate container.

Consistent with body fluid precautions.

9. Remove gloves. Wash hands. Consistent with aseptic

technique.

10. Put on new nonsterile gloves. Consistent with aseptic

technique.

11. Cleanse stoma and surrounding skin with warm tap

water or an ostomy soap as prescribed by agency policy.
Rinse skin well. Pat dry. Prevents injury to mucosa of
stoma, which has no nerve endings and is very friable,
and to surrounding skin.

12. Assess stoma and surrounding skin.
13. Measure stoma using measuring guide for appropriate

width and length of stoma at base. Ensures a good fit of
the ostomy appliance without excess skin at the base of
the stoma exposed to stool.

14. Place gauze pad over stoma while preparing the skin

barrier wafer and pouch for application. Wicks stool
away from skin and ensures a good seal of the wafer to
the skin.

15. Trace pattern of stoma opening onto paper backing of

skin barrier wafer. Ensures better fit and prevents lacer-
ation of the stoma or maceration of periostomal skin.

16. Cut skin barrier wafer approximately

1

/

16

to

1

/

8

inch

larger than stoma.

17. Attach a clean pouch to the skin barrier wafer. Make

sure the pouch is closed. Prevents leaking of stool under-
neath the wafer during application process.

18. Remove gauze pad from stoma. Makes it easier to visu-

alize the stoma.

19. Remove paper backing from skin barrier wafer. If speci-

fied by agency policy, apply a thin ring of Stomahesive
paste around the opening on the wafer and fan dry for
30–40 seconds or until dry to touch.

20. Place the skin barrier wafer on the skin with the opening

centered over the stoma.

21. Place hand or warm washcloth over pouch for 3–5 min-

utes. Helps seal the wafer to the skin.

22. Remove gloves. Wash hands. Reduces transmission of

microorganisms. (Figure 23)

DOCUMENTATION

1. Pouch change.
2. Condition and color of stoma and skin.
3. How procedure tolerated.
4. Amount and character of stool.

66

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 26

SKILL 26

Changing a Fecal Ostomy Appliance

FIGURE 23 Infant with ostomy bag.