Overview

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

General

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