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Jinnah Sindh Medical University

Institute of Nursing
Adult Health Nursing Skill

Procedure: Ostomy Care

A. Changing an ostomy appliance.

B. Changing and application of flange.

Purpose:

1. To collect effluent for assessment of the amount & type of output.

2. To prevent stoma and periostomal skin complication.
3. To distend the bowel to stimulate peristalsis and evacuation.

Required Equipment:

- Disposable gloves / latex gloves.

- Tissue / gauze / soft cloth (no cotton encouraged)
- Warm water
Simple water basin
- Bowl, bed pan, mackintosh
- Gauze pieces.
- Clean Pouch.
- Clean kidney tray
- Flange (appropriate size)
- Measuring Guide
- Scissors (curved)
- Stoma adhesive paste and powder.
- Clip

S. No. Procedure S U COMMENT

A Changing an Ostomy Appliance: (Pouch)
1. Identify client and introduce self.
2. Assess need to empty pouch when half to one
third full / pouch leakage.
3. Collect necessary equipment.
4. Explain procedure to the client.
Communicate acceptance and support to the
5.
client.
6. Provide privacy.
Assist the client to a comfortable sitting or
7. lying/semi-fowler position in bed or a sitting or
standing position in the bathroom.
8. Perform hand hygiene.
9. Wear disposable gloves.
Empty the pouch, remove and place it in the
10.
kidney tray. Leave the flange on its place.
11 Clean the stoma using soft cloth/tissue with warm
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water.
Inspect the stoma for color, size, shape and
12.
bleeding or any other changes.
Dry area thoroughly by patting with gauze and
13.
cover with wet gauze.
Empty the content of the pouch through the
14.
bottom opening in the toilet.
Assess the consistency and the amount of
15.
effluent.
Wash reusable bag and clip with running water
16.
and mild soap, rinse and dry.
Remove gauze and reattach clamped, clean pouch
to the flange and close the base of the pouch with
17.
appropriate clamp. Confirm proper fixation by
slightly pulling the pouch.
18. Remove and discard gloves.
19. Make client comfortable.
20. Restore / discard equipment as appropriate.
Document: Date and time of changing of pouch,
color and size of the stoma, amount, color and
21.
consistency of feces, client’s response, and any
other changes in stoma.

Change and Apply flange

S. No. B. Changing and Application of Flange S U COMMENT

1. Identify client and introduce self.
2. Assess need to change the flange.
3. Collect necessary equipment.
4. Explain procedure to the client.
5. Communicate acceptance and support to the
client.
6. Provide privacy.
7. Perform hand hygiene.
8. Put on gloves.
9. Empty and remove pouch and place it in the
kidney tray.
10. Peel the flange off slowly while supporting the
skin.
11 Clean the stoma with plain water and peri-
ostomal skin with warm water and dry with
gauze.
12. Inspect stoma for color, size, shape and
bleeding, and Peristomal skin for redness and
ulceration.
13. Measure the stoma with the help of a guide.
14. Place the measured guide on the back of the
flange and trace a circle of the same size as the
stoma opening.
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15. Fill in exposed skin around the stoma with

stoma adhesive paste.
16. Attach clean pouch to the flange and close the
base of the pouch with appropriate clamp.
Confirm proper fixation by slightly pulling the
pouch.
17. Make client comfortable.
18. Restore/discard equipment as appropriate.
19. Document: Date and time of changing of
flange, color and size of the stoma, amount,
color and consistency of feces, client’s
response, and any other changes in stoma.