Pre‐procedure

ActionRationale

1. 1.Show
   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.Show
   Ensure the patient is in a suitable and comfortable position.
   To allow good access to the stoma for cleaning and for secure application of the stoma bag. E
3. 3.Show
   Wash hands with soap and water and/or an alcohol‐based handrub. Apply personal protective equipment.
   To reduce the risk of cross‐infection (NHS England and NHSI [161], C).
4. 4.Show
   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

Procedure

1. 5.Show
   Remove the appliance. Gently peel the adhesive off the skin using an adhesive remover spray.
   To reduce trauma to the skin (Burch [38], [39], C).
2. 6.Show
   Remove excess faeces or mucus from the stoma and bridge with a piece of gauze soaked in tap water.
   So that the stoma and surrounding skin are clearly visible. E
3. 7.Show
   If using the Convatec bridge, slide the bridge gently to one side to ensure the mobile wing of the bridge is away from the stoma. Turn this wing so that it becomes flush with the bridge. Gently slide the bridge through the stoma loop.
   To prepare the bridge for removal. E
4. 8.Show
   If using the Coloplast bridge, slide the bridge gently to one side to ensure that the end that folds back off the bridge is away from the stoma. Fold back the end of the bridge. Gently slide the bridge through the stoma loop (see Action figure 8).
   To prepare the bridge for removal. E
5. 9.Show
   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. Also note if the stoma retracts once the bridge is removed.
   To prevent complications or treat existing problems. E
6. 10.Show
   Wash the skin and stoma gently with gauze soaked in warm water until they are clean.
   To promote cleanliness and prevent skin excoriation. E
7. 11.Show
   Dry the skin gently but thoroughly.
   The appliance will only attach securely to dry skin. E
8. 12.Show
   If the skin is red and/or broken, apply barrier film and notify the stoma care nurse. If the stoma is not a healthy red colour, inform the medical and/or stoma care nurse.
   To promote skin healing. E
9. 13.Show
   Apply a clean appliance.
   To contain effluent from the stoma. E

Post‐procedure

1. 14.Show
   Dispose of soiled wipes, the bridge, the used appliance, gloves and apron.
   To prevent environmental contamination. E
2. 15.Show
   Wash hands with soap and water or an alcohol‐based handrub.
   To reduce the risk of cross‐infection (NHS England and NHSI [161], C).