Ostomy Care: Step-by-Step Guide to Changing an Ostomy Pouch Safely
For Canadian ostomates and healthcare providers, mastering the ostomy pouch change procedure is essential for maintaining peristomal skin health, preventing leaks, and ensuring confidence in daily life. Approximately 15,000 ostomy surgeries are performed annually in Canada, and over 100,000 Canadians are living with an ostomy. This step-by-step guide covers everything from supplies to troubleshooting.
How Often Should You Change an Ostomy Pouch?
Most ostomy pouches should be changed every 3-7 days, depending on the type of stoma, output consistency, and skin condition. The pouch should be emptied when it is one-third to one-half full — typically 4-6 times per day for ileostomies and 2-4 times for colostomies. Key indicators that a change is needed include: Specification and standards detail is covered in ostomy supply planning for facilities.
- Leakage under the skin barrier
- Itching or burning sensation around the stoma
- Visible breakdown or discoloration of the barrier
- Odour escaping from the pouch
Supplies Needed for an Ostomy Pouch Change
Before starting, gather the following supplies:
- New ostomy pouch and skin barrier (one-piece or two-piece system)
- Stoma measuring guide or template
- Scissors (for cutting the barrier opening)
- Stoma paste or convex ring (if needed)
- Adhesive remover wipes or spray
- Skin barrier wipes or powder
- Gentle cleanser or warm water
- Soft washcloth or gauze
- Trash bag for used supplies
- Optional: ostomy belt, stoma powder, skin filler
Figure 1: Coloplast SenSura® Mio Convex two-piece ostomy system. (Source: Coloplast Canada)
Step-by-Step Ostomy Pouch Change Procedure
- Prepare the area: Lay down a towel or underpads. Remove the old pouch by gently pushing the skin away from the barrier — never pull the barrier off the skin. Use adhesive remover wipes to dissolve the adhesive and prevent skin trauma.
- Clean the stoma: Gently clean the peristomal skin and stoma with warm water and a soft cloth. Pat dry completely. Avoid alcohol-based wipes, harsh soaps, or moisturizing cleansers.
- Inspect the skin: Check for redness, rash, bleeding, or irritation. Healthy peristomal skin should look the same as skin elsewhere on the abdomen.
- Measure the stoma: Use a measuring guide to trace the exact size and shape of the stoma. The barrier opening should be 1/8 inch (3 mm) larger than the stoma.
- Cut the barrier: Trace the measurement onto the back of the skin barrier and cut carefully. Round the edges to prevent sharp corners from lifting.
- Apply stoma paste or ring: For flush or irregular stomas, apply a convex ring or stoma paste around the opening to create a custom seal.
- Apply the barrier: Remove the backing from the skin barrier. Center the opening over the stoma and press the barrier onto the skin, working from the stoma outward. Hold for 30-60 seconds to ensure proper adhesion.
- Attach the pouch: If using a two-piece system, snap the pouch onto the flange. Ensure you hear the "click" confirming a secure seal. For one-piece systems, the pouch is pre-attached.
- Secure the system: Apply gentle hand pressure over the entire barrier for 2-3 minutes. Body heat helps activate the adhesive.
- Final check: Ensure the pouch is properly positioned, the drain is closed, and there are no gaps or wrinkles in the barrier seal.
Figure 2: Hollister CeraPlus™ Ostomy Skin Barrier with Ceramide Technology. (Source: Hollister)
Troubleshooting Common Ostomy Issues
| Problem | Possible Cause | Solution |
|---|---|---|
| Leakage under barrier | Opening too large; stoma retraction | Re-measure stoma; try convex barrier |
| Itchy/red skin | Allergic reaction; fungal infection | Switch barrier brand; consult WOC nurse |
| Pouch odour | Poor seal; diet; worn filter | Check seal; replace filter; use deodorant |
| Barrier won't stick | Moisture; powder residue | Dry skin thoroughly; use skin prep wipe |
| Bleeding stoma | Friction; trauma; vitamin deficiency | Gentle cleaning; apply light pressure; see doctor if persistent |
Product Selection for Canadian Ostomates
In Canada, ostomy supplies are available through provincial programs such as Ontario's Assistive Devices Program (ADP), Alberta's AADL, and BC's Medical Supplies and Equipment (MSE) Program. Leading brands available through Canadian distributors include:
- Coloplast: SenSura® Mio, Assura®, Alterna®
- ConvaTec: ActiveLife®, Sur-Fit® Natura®, Durahesive®
- Hollister: New Image™, CeraPlus™, Vertical™
- Smith+Nephew: OpSite® Flexigrid™
CliniEco Medical offers a full range of ostomy care products from all major manufacturers for Canadian hospitals, LTC facilities, and home care. Our team can assist with product selection and bulk procurement for your facility.
Related reading: learn more about Canadian medical procurement in our business hub.
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