21.15 Checklist for Ostomy Appliance Change
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), gauze, pads, 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 them 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 new 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. (If a pattern is available, cut the new wafer prior to removing the pouch). No more than 1/8th inch (2 mm) 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 used 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.