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6.26 Stoma bag change

This procedure may also be applied when teaching a patient how to care for their stoma.

Essential equipment

  • Personal protective equipment
  • Dry wipes
  • New appliance
  • Measuring device or template
  • Scissors
  • Disposal bags for used appliances and wipes
  • Adhesive remover spray
  • Other relevant accessories, for example protective film, and seals and washers
  • Bowl of warm water
  • Gauze
  • Jug or receiver for contents of appliance
  • Protection for bed or patient's clothing

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C).
  2. 2.
    Ensure that the patient is in a suitable and comfortable position where they will be able to watch the procedure, if well enough. A mirror may be used to aid visualization.
    To allow good access to the stoma for cleaning and for secure application of the stoma bag. The patient will become familiar with the stoma and will also learn about the care of the stoma by observing the nurse. E
  3. 3.
    Use a small protective pad to protect the patient's clothing from drips if the effluent is fluid.
    To avoid the necessity of changing clothing or bedclothes and to avoid demoralization of the patient as a result of soiling. E
  4. 4.
    Wash hands with soap and water and/or an alcohol‐based handrub. Apply personal protective equipment: non‐sterile gloves and a plastic apron.
    To reduce the risk of cross‐infection (NHS England and NHSI [161], C).

Procedure

  1. 5.
    If the bag is of the drainable type, empty the contents into a jug before removing the bag.
    For ease of handling the appliance and prevention of spillage. E
  2. 6.
    Remove the appliance slowly using an adhesive remover. Peel the adhesive off the skin with one hand while exerting gentle pressure on the skin with the other.
    To reduce trauma to the skin (Burch [39], C).
  3. 7.
    Fold the appliance in two to ensure there is no spillage and place it in a disposal bag.
    To ensure safe disposal according to environmental policy (DEFRA [63], C).
  4. 8.
    Remove excess faeces or mucus from the stoma with a piece of gauze soaked in tap water.
    So that the stoma and surrounding skin are clearly visible. E
  5. 9.
    Examine the skin and stoma for soreness, ulceration and other unusual phenomena. If the skin is unblemished and the stoma is a healthy red colour, proceed. Report any abnormalities to the stoma care nurse or surgical team.
    To identify complications or to treat existing problems. E
  6. 10.
    Wash the peristomal skin and stoma gently with gauze soaked in warm water until they are clean.
    To promote cleanliness and prevent skin excoriation. E
  7. 11.
    Dry the peristomal skin gently but thoroughly.
    Because the appliance will only attach securely to dry skin. E
  8. 12.
    Measure the stoma and cut appliance, leaving 3 mm clearance. Apply a clean appliance.
    The appliance should provide skin protection. The aperture should be cut just a little larger than the stoma so that effluent cannot cause skin damage, but it should not touch the stoma (Kirkwood [111], C).

Post‐procedure

  1. 13.
    Dispose of soiled tissues, the used appliance, gloves and apron as per local policy.
    To ensure safe disposal. E
  2. 14.
    Wash hands thoroughly using soap and water or an alcohol‐based handrub.
    To prevent the spread of infection by contaminated hands (NHS England and NHSI [161], C).
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