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05.01 Stoma Care (Colostomy bag)

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  1. Purpose
    1. Caring for a stoma involves assessing the following:
      1. Perfusion of the stoma
        1. Color
        2. Moisture
      2. Skin integrity around the stoma
      3. Function of the stoma itself
        1. Color, consistency of output
    2. Stoma barrier wafers and bags only NEED to be changed every 3-5 days or if there is leakage
      1. Can assess the stoma through a clear bag
      2. However – if the bag is opaque and you cannot see the stoma, you MUST remove it to assess the stoma itself.
        1. 1-piece – remove and replace the whole thing with the procedure below
        2. 2-piece – remove just the bag, leave the wafer intact
    3. Output type
      1. Colostomy – formed, firm, brown stool
      2. Ileostomy – loose brownish-green stool
      3. Urostomy – urine

Nursing Points


  1. Supplies needed
    1. Barrier cream/paste
    2. New barrier/wafer and stoma bag
      1. 1-piece or 2-piece
    3. Small scissors
    4. Skin prep
    5. Washcloth and warm soapy water
    6. Towel x 2
      1. May use incontinence pad

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Explain procedure to patient
    2. Gather supplies
    3. Perform hand hygiene
    4. Don clean gloves
    5. Place a towel or incontinence pad below the patient on that side
    6. Inspect the output from the stoma for appropriate color and consistency
      1. Look in the existing bag
      2. If bag is opaque – empty the bag into a urinal or bedpan, then dispose in the toilet
    7. Carefully remove the stoma wafer by pressing it away from the skin
    8. Discard in appropriate waste container
    9. Use washcloth with warm soapy water to clean around the stoma and the stoma itself – do NOT scrub
    10. Pat the skin dry with a towel or dry cloth
    11. Inspect the stoma itself
      1. Should be dark pink and moist
      2. BAD = dark red, purple, dusky/cyanotic
    12. Measure the stoma for correct size of pouching system
    13. Cut the hole of the wafer approximately ⅛ inch larger than the stoma
    14. Apply skin prep around the stoma
    15. Remove paper backing from wafer, apply to skin around stoma, with stoma in the hole
    16. If any creases occur that you can’t smooth out, use barrier paste to fill in – let dry 1-2 minutes
    17. For 2-piece → apply the wafer, then snap on the bag
    18. Ensure the bottom opening of the bag closed and clamped appropriately
      1. Some have a separate clamp, some have velcro built in
      2. Follow manufacturer’s instructions
    19. The opening of the bag should face towards the patient’s knees if they were sitting
      1. NOTE – if your patient is bedridden, face the pouch to follow gravity (may  be to the side)
    20. Discard used supplies appropriately
    21. Remove gloves
    22. Perform hand hygiene
    23. Document procedure and patient response / tolerance

Patient Education

  1. Patients should be taught how to self-care for their own stoma
    1. They can even  do this in the hospital – just need to get them the right supplies

Reference Links

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Video Transcript

In this video, we’re going to talk about stoma care. Now, the wafer and bag for an ostomy only NEEDS to be changed every 3 days, or if it’s leaking. But, you still need to be able to assess the stoma itself. In this case we’re going to show you how to replace the bag and clean and assess the stoma. Start by putting a towel under the patient on the side of the stoma.

The first thing you want to do is assess the output from the stoma. If you have a clear bag, you can visualize it that way, otherwise you’ll need to empty the bag into a urinal so you can measure it, then discard in the toilet.
In order to clean and assess the stoma, we have to remove the bag. You’ll start by peeling the wafer and pushing the skin down away from it. You may need to use warm water or alcohol here if the adhesive is tough.
Now you want to clean the stoma and around it with a washcloth with warm soapy water. Use gentle strokes, don’t scrub.
Then you will pat the skin dry with a towel. Again, don’t rub.
Now that it’s clean, you can inspect the stoma itself. It should be light to dark pink and moist. What you don’t want to see is dark red, pale, purple, or blue-ish – none of those are good signs, they all represent problems with perfusion and should be reported right away. And of course, look for any skin breakdown.
Now you’re going to measure the stoma and cut the hole of the wafer to be about ⅛ inch larger than the stoma.
You’ll apply skin prep or barrier to the skin around the stoma, remove the paper backing from the wafer, and apply it to the skin with the stoma in the center of the hole.
If you get any spaces or creases you can’t smooth out, you can use barrier paste to fill them in.
If you’re using a 2-piece, you’ll apply the wafer first and then snap on the bag. Then make sure the bag is closed and sealed based on the type of bag you have.
Discard your supplies, wash your hands, and document your findings, including the output measurement.

So that’s it for stoma care – remember the little things might change depending on the type of stoma your patient has and what kind of device you’re using. But always look at the stoma and the skin around it.

Now, go out and be your best self today. And, as always, happy nursing!