How to Change an Ostomy
The first few times you change your ostomy on your own without the guidance of a healthcare professional, it is completely normal to feel terrified, unprepared and worried you’re going to do something wrong. The first time I changed my bag on my own I threw up from sheer panic. Now, I can change my bag in under three minutes, no problem. So, take a deep breath and know that everything is going to be just fine. You WILL be able to change your bag on your own. It may take a few tries to get your technique down, but eventually, it will all become second nature. Be patient with yourself and recognize that there is a learning curve. This is all new for you, but you can do this!
How long does it take to change an ostomy?
Before you begin your change, make sure to leave yourself enough time for mistakes to happen. Even a seasoned pro will tell you there is nothing worse, or more stressful, than trying to change your bag on a tight schedule. Bag changes, especially in the beginning, can be very unpredictable. Your stoma may decide to start acting up mid-change and start spewing like a faucet. If this happens, just take a deep breath and let it happen. Use a washcloth or paper towel to catch the output and clean your skin. If you can catch the output, you may be able to continue with your change. However, if you end up wiping off all your skin prep, just start again from the beginning (as many times as you need to). If this happens, remember it’s okay!
When should I change my ostomy?
Eventually, you will figure out the ideal time to change your bag each week. For some its every day, for others it's every few days. Each person is different. By paying attention to your stoma and how it responds to what and when you eat, you will notice patterns that will key you in on when you should change your bag. For example, I know that I have to change my bag every 3-4 days (unless I have a leak) and that I have the best results (least amount of output) when I change my bag in the morning, about 20-30 minutes after getting up, before I eat or drink anything. In time, you will discover what works best for you, but to get you started here are a few tips to try while you’re still learning the ropes.
Steps for a Successful Bag Change
- Organize your supplies. Keep all of your supplies neatly stacked together in a place that is easy to reach during a change. Make sure you have extra supplies on hand, just in case. Most people store supplies in a closet, drawer, basket/bin, or under the sink in the room where they change their ostomy. Keep track of how much of each product you have so you can order more when you start to run low.
- Set out supplies needed for each step of the change. Do all of this BEFORE you take off your bag. On a clean surface (near a sink and a mirror), lay out all of your ostomy changing supplies in the order in which you will use them. Begin by setting out a small plastic bag for trash and a roll of paper towels (or a few washcloths) in a place that’s easy to reach from the sink. Then set out the flange, tracing template of stoma size, marker, and medical scissors. Next, set out alcohol wipe, stoma powder, skin medicine (if you have any), skin prep wipe, and barrier ring. Open the products and prepare them for us. The less you have to mess around with them during the change, the better. If you use a 2-piece pouching system, set out your bag in a place that is easy to reach. Make sure you secure the drainable bottom of the bag at this time. Choose between a 1-piece or 2-piece pouching system based on your preference. Find what works best for you. Finally, set out a blow dryer, if you have one.
- Cut the flange. Use the plastic cover of an old flange with your stoma hole cut out of the center as a template. Place the template over the new flange. Using a marker, trace the circle in the center of the flange. Use medical scissors to cut along the line on the new flange. Put away or set aside scissors, marker, and template. *If you do not have an old flange template to trace because your stoma is still changing size, use the measuring guide that came in your flange box to determine the size of your stoma. Once you know the size, trace a circle on the center of your flange and use medical scissors to cut along the line. If you have to measure your stoma size with the sizing guide, you will have to do this step after you clean your skin (step 6).
- Use paper towels to keep clean. Tuck two sheets of paper towel into the top of your pants underneath the bag and rest the paper towel on the counter in front of you. The paper towel will catch any output that may come out during the change. This prevents a mess from getting on your clothes or the counter. Be conscious of the paper towel when you move so it doesn’t slide off of the counter.
- Remove bag. Use an alcohol wipe to remove your appliance. Start at the top and slowly begin using the alcohol wipe to remove the flange from the skin. If there is any sticky residue from the previous barrier, use the alcohol wipe to remove it.
- Clean the skin. Using warm water and paper towels or a washcloth gently clean the skin and the stoma. You can choose to use soap during this step, but it is not necessary. As my doctor explained to me, “you didn’t use soap to wipe your bum, so why would you start now.” However, if it makes you feel cleaner, use soap. But stay away from “moisturizing” soap, as they will prevent the skin from forming a strong seal with the barrier and flange, which can cause leaks to happen more frequently. At this time, notice how your skin and stoma looks. Is it healthy? Is it red and irritated? Is it the right shape and size? If it is irritated, pay attention to this and see if it continues at your next change. If it does, it may be an indication that you are having a negative reaction to the products you are using. You may want to try a different brand. You should also contact your doctor or stoma nurse and inform them of your symptoms as you may require medicine or medical attention.
- Apply stoma skin powder. On a folded piece of paper towel, shake out a small amount of stoma powder. Dab the powder on the skin around the stoma, covering the entire area that will be under the flange. Don’t apply too much powder, just a light coat will suffice. If you have a medical powder prescribed by your doctor or stoma nurse, use this instead of the stoma powder. At this time, apply any other prescribed medicine (powder, spray, cream, etc.).
- Use skin prep. Dab a skin prep protective wipe over the stoma powder. Do not wipe the area too hard or you will remove the powder. Start near the stoma and move outward, coating the entire area that will be covered by the flange.
- Dry skin. Use a blow dryer on the low or medium heat setting to dry the skin. It is helpful to use a blow dryer because the heat will help the barrier ring and the flange stick better. If you do not have a blow dryer, use something, like a sheet of paper towel or your hand, to fan the area and dry the skin. Allow the skin to dry completely before moving on to the next step.
- Apply barrier ring or paste. If you use a barrier ring, stretch and mold the ring to the approximate size of your stoma. Place the barrier ring around the stoma, making sure it is firmly pressed to the skin. It is helpful to use the mirror to help place the barrier. Start at the bottom of your stoma and place the barrier there first, then pull it over the top of your stoma so it is completely surrounded. The bottom of the stoma, where most of the output will pass over, is where you want the closest seal. If you leave a gap between your stoma and the barrier ring or paste, the output could get onto your skin, which will cause burning and discomfort. If you use paste instead of a ring, spread the paste around your stoma in a thick, even layer. You can also choose to apply the paste directly to the flange before applying the flange to your skin.
- Apply flange. Press the pre-cut flange firmly to your skin. Apply the same technique as the one used to apply the barrier ring. Start at the bottom of your stoma and work upward.
- Attach bag. If using a 2-piece pouching system, snap bag into place. It should snap together audibly, like Tupperware. Check around the ring to be sure the bag is completely snapped into place.
Congratulations, you did it!
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