A Nurse Is Replacing The Ostomy Appliance

Ostomy Appliance Change: A Comprehensive Guide for Nurses

Changing an ostomy appliance is a routine procedure for nurses, but it's a crucial one demanding precision and gentleness. This comprehensive guide will walk you through the process step-by-step, emphasizing best practices for patient comfort and minimizing the risk of complications. We'll cover everything from preparing the supplies to post-change care, ensuring you're equipped to handle this essential nursing task with confidence.

Preparing for the Ostomy Appliance Change

Before beginning, meticulous preparation is key. This minimizes disruption for the patient and reduces the chance of error. Here’s what you need:

1. Gather Your Supplies:

• New ostomy appliance: Choose the correct size and type based on the patient's stoma and individual needs. Remember to consider factors such as the output consistency and the patient's skin sensitivity. Different appliances are designed for different needs – some have convex shapes for recessed stomas, while others offer different wafer materials to better manage skin sensitivity.
• Clean gloves: Always prioritize hygiene.
• Skin barrier wipes or cleanser: These are specifically designed for sensitive peristoma skin and help remove any remaining adhesive or fecal matter. Avoid using soap or harsh chemicals, which can irritate the skin.
• Measuring tape: While you may know the patient's typical size, it's always wise to double-check the stoma measurement before applying a new appliance.
• Scissors: Sharp, clean scissors are needed for trimming the wafer if necessary.
• Ostomy paste or powder (if needed): This can be used to create a smooth, secure seal around the stoma, especially if the stoma is uneven or the patient has peristomal skin issues.
• Protective barrier film: This helps to protect surrounding skin from irritation caused by moisture or stool.
• Disposable towel or chux: These absorb any spills or leakage during the procedure.
• Plastic bag for soiled materials: Proper disposal of used materials is paramount for hygiene and infection control.
• Pain medication (if needed): Some patients may experience discomfort during the appliance change. Having analgesics readily available can enhance the patient's experience.
• Skin protectant: A gentle skin protectant can aid in healing minor skin irritations and prevent future issues.

2. Assessing the Patient and the Stoma:

• Observe the stoma: Note its color, size, and any signs of irritation or bleeding. A healthy stoma is typically pink or red and moist. Any changes should be reported immediately to the physician.
• Assess the surrounding skin: Look for signs of irritation, redness, rash, or breakdown. These require special attention and may necessitate a change in product or additional skin protection.
• Check the current appliance: Note how well the appliance is adhering to the skin, and the condition of the adhesive. Observe the consistency of the output to inform choices of future appliances.
• Patient comfort and readiness: Explain each step clearly to the patient, ensuring they are comfortable and understand the process. Allow time for questions and address any concerns.

Removing the Old Ostomy Appliance

This stage requires patience and gentle techniques to avoid causing pain or skin damage.

1. Preparing the Patient:

• Position the patient comfortably: Ensure the patient is comfortable and able to assist as needed. This may involve positioning them on their side or back, depending on their preference and the location of the stoma.
• Provide privacy: Maintain the patient’s privacy during the procedure, ensuring they feel comfortable and secure.

2. Removing the Appliance:

• Wash hands thoroughly: Again, hygiene is paramount.
• Gently peel back the edges of the appliance: Start at one edge and gently peel back the adhesive, working your way around the stoma. Avoid pulling directly on the stoma. If the appliance is stuck, use warm water or specialized adhesive remover to help loosen it.
• Cleanse the skin: Use skin barrier wipes or cleanser to gently remove any residual adhesive or fecal matter. Work in a circular motion, avoiding harsh scrubbing.
• Assess the skin: Carefully examine the peristomal skin for any signs of irritation, redness, or breakdown.

Applying the New Ostomy Appliance

This is where precision is crucial to ensure a proper fit and prevent leakage.

1. Measuring the Stoma:

• Use a measuring tape: Accurately measure the stoma's diameter. Measure in several directions to account for any irregularities. This is essential for selecting the correct size of the ostomy opening on the new appliance.

2. Preparing the New Appliance:

• Remove the backing: Carefully peel back the protective backing from the adhesive wafer, avoiding touching the adhesive surface.
• Cut the opening: Using the measuring tape and the new appliance's template (if provided), cut an opening slightly larger (approximately 1/16 inch) than the stoma measurement. This allows room for the stoma to expand and prevents the appliance from pressing against the stoma.

3. Applying the Appliance:

• Position the appliance: Carefully center the appliance over the stoma, ensuring it’s aligned properly. Gently press down firmly around the stoma and surrounding skin to ensure a secure seal.
• Smooth out wrinkles: Check for any wrinkles or air bubbles under the wafer. Gently smooth these out to prevent leakage.
• Use paste or powder (if needed): If the stoma is uneven or there are skin irregularities, use ostomy paste or powder to create a smooth, secure seal around the stoma. This will help prevent leakage and skin irritation.

4. Post-Appliance Change Care:

• Observe the patient: Monitor the patient for any signs of discomfort or leakage.
• Patient education: Teach the patient or caregiver how to properly care for their stoma and change the appliance.
• Document the procedure: Record the date, time, and any relevant observations about the stoma and surrounding skin in the patient’s medical record.

Managing Potential Complications

While changing an ostomy appliance is a routine procedure, several complications can occur. Early identification and management are crucial.

1. Peristomal Skin Irritation:

This is a common issue caused by friction, leakage, or exposure to stool. Careful cleansing, proper appliance fitting, and the use of skin protectants are essential preventative measures. If irritation occurs, appropriate treatment should be initiated immediately.

2. Stoma Prolapse:

This involves the protrusion of the stoma beyond the abdominal wall. This is less frequent, but if observed, notifying a physician immediately is vital.

3. Stoma Stenosis:

Narrowing or constriction of the stoma can impede the flow of stool and cause obstructions. If this is suspected, immediate medical intervention is needed.

4. Stoma Retraction:

The stoma retracts into the abdominal wall. This can make it difficult to apply an appliance. Appropriate modifications in the ostomy appliance are necessary.

5. Parastomal Hernia:

This involves the protrusion of bowel through a weakness in the abdominal wall near the stoma. This requires assessment and potentially surgical correction.

Beyond the Technical: The Human Element

While mastering the technical aspects of ostomy appliance changes is crucial, remember that this procedure profoundly impacts the patient's quality of life. Empathy and compassionate care are essential elements.

• Communication is key: Explain the process clearly and patiently, answering any questions the patient or caregiver may have. This helps build trust and alleviate anxiety.
• Respect patient dignity: Maintain patient privacy and ensure they feel comfortable and respected throughout the procedure.
• Personalized approach: Individual needs vary. Adapt your approach to each patient's unique situation and preferences.
• Ongoing support: Provide ongoing support and education to empower the patient to manage their ostomy effectively.

Changing an ostomy appliance is more than just a technical skill; it's an act of compassionate care. By following these guidelines, you can ensure you perform this procedure safely and effectively while promoting patient comfort and wellbeing. Remember, consistent practice, attention to detail, and a patient-centered approach are the cornerstones of excellent ostomy care. Regular continuing education and staying updated on the latest advancements in ostomy care will enhance your skills and proficiency in this essential nursing task.