Ostomy Bags

Things to Consider

  • Assess the site when student arrives at school and throughout school day (or as indicated in health plan).
  • Check healthcare provider’s orders.Orders may address dressing changes, site care requirements, pouch emptying and cleaning.

Procedure

Changing the Ostomy Bag

  1. Assemble supplies and place on clean surface.
  2. Explain procedure to student at their level of understanding.Allow to student to participate as appropriate.
  3. Wash hands. If student will be participating have them wash their hands as well.
  4. Don gloves.
  5. Remove old bag.
    1. Push the skin away from the bag, instead of pulling the bag off of the skin
    2. If it is painful or difficult to remove the wafer from the skin, use an adhesive remover if ordered.
    3. Tuck gauze into the opening of the pouch that has been removed to help with the odor.
  6. Clean skin using soap, warm water, and gauze.Do not scrub.
  7. Dry skin completely: gently pat dry with soft cloth or gauze.
  8. Assess skin and inspect for redness, irritation, bleeding, or blisters.Notify parent/guardian if noted.
  9. Assess stoma for:
    1. Pink, moist, stoma without sings of infection (no darkening in color or bluish color)
    2. No signs of parastomal hernia (no bulging)
    3. No signs of prolapse (protrusion of the intestine through stoma)
    4. No signs of retraction
  10. Use skin prep IF ordered and IF necessary for appliance adhesive.
  11. Measure stoma with measuring guide per student specific guidelines.
  12. Trace the opening onto the paper backing of the pouch/wafer.
  13. Use scissors to cut along tracing.
    1. If using a one-piece system, place your finger into the small pre-cut opening and push away the pouch before you start to cut being careful not to cut through the front of the pouch.
    2. If you cut through the front of the pouch, use a new pouch.
  14. Smooth any jagged edges with fingers or scissors.Remove the white paper backing from the skin barrier.
    1. It may help to “warm” the wafer between your hands to make it easier to conform to the contours of the skin.
  15. Securely apply pouch closure to the bottom of the pouch.
  16. If ordered, place skin barrier or protectant around stoma.
  17. Peel off backing from adhesive.
  18. Apply adhesive to bag or remove backing from adhesive.
  19. If ordered, apply stoma adhesive paste to the back of the skin barrier at the edge of the cut opening and set aside for one minute.
  20. Center new pouch over stoma.
  21. Press bag firmly against skin barrier for 30 seconds to create seal between body and wafer/pouch, to prevent leaks; avoid wrinkles.
  22. Remove gloves and wash hands. If student assisted with procedure have them wash their hands.
  23. Document in student health record.

Emptying pouch

  1. Assemble supplies.
  2. Wash hands and don gloves.
  3. Open bottom edge of pouch by unwinding closure or opening clamp.
  4. Empty contents into a container or the toilet (measure if ordered).Changes in fecal character, such as diarrhea, should be reported to family and/or provider.
  5. Cleanse the bottom of the pouch with clean toilet paper, diaper wipes (or other alcohol free wipe), or paper towel.
  6. Clouse pouch.
  7. Remove gloves and wash hands.
  8. Document in student health record.

*All procedures found on this page are borrowed with permission from the Wisconsin School Health Services Project (2017) unless otherwise indicated. These are sample protocols/procedures. Please consult your own district’s policies and procedures before conducting any healthcare procedures.