21.15: Checklist for Ostomy Appliance Change
- Page ID
- 44711
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)
\( \newcommand{\dsum}{\displaystyle\sum\limits} \)
\( \newcommand{\dint}{\displaystyle\int\limits} \)
\( \newcommand{\dlim}{\displaystyle\lim\limits} \)
\( \newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\)
( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\)
\( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)
\( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\)
\( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)
\( \newcommand{\Span}{\mathrm{span}}\)
\( \newcommand{\id}{\mathrm{id}}\)
\( \newcommand{\Span}{\mathrm{span}}\)
\( \newcommand{\kernel}{\mathrm{null}\,}\)
\( \newcommand{\range}{\mathrm{range}\,}\)
\( \newcommand{\RealPart}{\mathrm{Re}}\)
\( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)
\( \newcommand{\Argument}{\mathrm{Arg}}\)
\( \newcommand{\norm}[1]{\| #1 \|}\)
\( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)
\( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\AA}{\unicode[.8,0]{x212B}}\)
\( \newcommand{\vectorA}[1]{\vec{#1}} % arrow\)
\( \newcommand{\vectorAt}[1]{\vec{\text{#1}}} % arrow\)
\( \newcommand{\vectorB}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\( \newcommand{\vectorC}[1]{\textbf{#1}} \)
\( \newcommand{\vectorD}[1]{\overrightarrow{#1}} \)
\( \newcommand{\vectorDt}[1]{\overrightarrow{\text{#1}}} \)
\( \newcommand{\vectE}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{\mathbf {#1}}}} \)
\( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)
\(\newcommand{\longvect}{\overrightarrow}\)
\( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)
\(\newcommand{\ket}[1]{\left| #1 \right>}\)
\(\newcommand{\bra}[1]{\left< #1 \right|}\)
\(\newcommand{\braket}[2]{\left< #1 \vphantom{#2} \right| \left. #2 \vphantom{#1} \right>}\)
\(\newcommand{\braopket}[3]{\left< #1 \vphantom{#2}\vphantom{#3} \right| #2 \vphantom{#1}\vphantom{#3} \left| #3 \vphantom{#1}\vphantom{#2} \right>}\)
\(\newcommand{\qmvec}[1]{\mathbf{\vec{#1}}}\)
\(\newcommand{\op}[1]{\hat{\mathbf{#1}}}\)
\(\newcommand{\expect}[1]{\langle #1 \rangle}\)
\(\newcommand{\dfn}[1]{\emph{\textbf{#1}}}\)
Use the checklist below to review the steps for completion of an “Ostomy Appliance Change.”
Steps
Disclaimer: Always review and follow agency policy regarding this specific skill.
- Gather supplies: washcloth and warm water, stoma products/appliances per order/patient preference (wafer, bag, clip), sizing measures, scissors, pen, nonsterile gloves, skin prep or other skin products per patient preference, and wastebasket.
- Perform safety steps:
- Perform hand hygiene.
- Check the room for transmission-based precautions.
- Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Explain the process to the patient.
- Be organized and systematic.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.
- Ensure the patient’s privacy and dignity.
- Assess ABCs.
- Set the bed to a comfortable height; raise the opposite side rail.
- Ask the patient about preferences, usual practices, care, and maintenance at home.
- Apply nonsterile gloves.
- Position the patient according to patient status:
- Assist the patient to the bathroom and have him/her sit on the toilet to be near the sink for ease of process.
- If in bed, uncover the patient, exposing only the abdomen. Apply drape/chux under the patient or ostomy pouch. Place the wastebasket near the bed.
- Empty the pouch depending on the type of the appliance and the location type of procedure:
- Remove the pouch and empty it into the toilet.
- Set pouch aside in the basin or receptacle if at bedside.
- Assess ostomy bag contents, and remove current ostomy appliance (keep clamp if present).
- Remove adhesive residue from the skin with adhesive remover wipes.
- Cleanse the stoma and surrounding skin with gauze and room temperature tap water; pat dry the skin.
- Assess the condition of the stoma and peristomal skin.
- Place the gauze pad over the stoma while you are preparing the new wafer and pouch.
- Trace the pattern onto the paper backing of the wafer and cut the wafer. No more than 1/8 inch of skin around the stoma should be exposed for correct fit.
- Apply skin prep and wait until tacky (optional).
- Remove the gauze pad from the orifice of the stoma.
- Remove the paper backing from the wafer and place it on the skin with the stoma centered in the cutout opening of the wafer; press gently on the wafer to remove air/seal to the skin.
- Apply pouch to wafer with clamp on pouch and opening in downward position.
- Attach and close the pouch clamp.
- Dispose of old supplies and wrappings.
- Remove your gloves and perform hand hygiene.
- Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
- Ensure safety measures when leaving the room:
- CALL LIGHT: Within reach
- BED: Low and locked (in lowest position and brakes on)
- SIDE RAILS: Secured
- TABLE: Within reach
- ROOM: Risk-free for falls (scan room and clear any obstacles)
- Document the procedure and related assessment findings. Report any concerns according to agency policy.