[MUSIC PLAYING] Hi. My name is Maggie Mae Baenziger. And I'm one of the certified wound ostomy incontinence nurses here at the University of Chicago. What we're going to do today is we're going to demonstrate how a pouching system is changed. And I'm here with Debra. Debra is one of our past patients.
Thank you, Maggie. Hi. My name is Debra. I've had an ostomy for 17 years. And today, I'd like to walk you through the process of how to change your ostomy pouch.
Before we get started, I wanted to point out to you that we've laid everything out in front of us here for demonstration purposes. But the majority of people, when they change their ostomy pouch, do so in a bathroom. They lay everything out on the sink. And then they get started with the procedure.
Here I have my wet paper towels, my dry paper towels, an ostomy pouch, my scissors, a ring, and a bag to dispose of all the old debris. I know that my stoma is one and a fourth inch. So what I'm going to do is first pre-cut along the one and a fourth inch circle.
Now while Debra is doing that, I will tell you that, at times, it's smart to measure your stoma, especially right after surgery. The stoma is going to change in size and shape. Just to be assured that the size of the opening in the skin barrier or the wafer matches the stoma because we want all of the skin to be covered with the adhesive. That way stool won't make any contact with the skin. And there won't be any issues with skin irritation later.
Now that I've cut the one and a fourth inch circle, I removed the paper on the back to reveal the sticky side. And I put this, again, in the trash. My next step is to apply the ring around the circle of the wafer.
And so what Debra is going to do is she's going to stretch out that ring to mirror the size of the hole we cut. Some patients prefer to place the ring directly around their stoma, and then place their pouching system over that. But we're just going to show you today how you put it on the back of the pouch. The ring is very forgiving. So you can kind of stretch and mold it.
After I apply the ring and everything is laid out, the next step is to remove my old pouch.
Now Debra is going to gently remove the outer adhesive. So you can see what she's doing here. She's rolling out the edges to get it started. And then once she gets the edges rolled out, she can gently press her skin away from the adhesive. And then she's going to go around the outer edge and go from the top and pull the pouch completely off.
Now that I removed it, I will roll it up and put it in the bag. Then I'll take a dry paper towel and start removing some of the debris that's on the stoma.
Remember, stomas don't have any nerve endings to them. So she's not causing herself any discomfort. She's trying to get any stool that might be loose off, so it won't get on her skin when she starts to clean her skin.
Now that I've removed that, I'll take a wet paper towel and wash the skin.
And as Debra pointed out, it's a wet paper towel. Water from the sink only. There's some people who would prefer to use soap, which is OK, but many soaps have moisturizers in them. So you need to be sure that the type of soap you're using and then do a good rinse job afterwards. I would also recommend avoiding baby wipes or cleansing cloths because it could contain an ingredient which impedes the adhesive from adhering to your skin.
This is also a great time while you're cleaning to take a look at the skin and see if there's any skin damage or irritation around the area. You might see a little bit of pinkness, which is pretty normal. When you take off any kind of adhesives, your skin will start to pink up.
Next, I'm going to take a dry paper towel. And I'm going to make sure that the skin around my stoma is dry.
One of the things that I need to point out is that Deborah has had her stoma for so long, so she knows that it measures at one and a quarter-inch opening. But if it wasn't, I wanted to demonstrate to you how a person might measure to know what size to cut the opening. Many people use a measure guide that looks similar to this. It has a variety of sizes to start with and what you might think is a reasonable size.
So for instance, I would just hold this up over. And you can see that there's a lot of skin exposed to her stoma which, if we cut the hole this big, would cause skin damage around her stoma. So we need to find one that fits snugly, just like her one and a quarter inch that she measures to.
Now that my skin is dry, the next step is to apply the pouch, which I've already prepared with the ring. And I'm going to center it over the stoma.
And you can see why it's advisable to stand. Debra has a great view of her stoma in this position. So she can easily center the pouch. And she's pressing down right along the stoma edges and the outer portion of the wafer to ensure that the adhesive is in place. Some patients also prefer to apply their hand over the pouching system. The warmth of her hand is going to warm the adhesive to her skin, which will make it seal quicker.
So now that the pouch is on what Debra is going to do is she's going to close her pouch. To do this she would take her pouch, and she would roll it towards herself three times. And then she would take these Velcro edges and secure them to the side.
Now that my ostomy pouch is on, the next step is to dispose of the old pouch. So I take the bag that has been supplied in the box of ostomy pouches. And I'll just tie up everything and put it in the trash, seal any type of odor.
We'll briefly go over now how to empty your pouch. You want to empty your pouch when it fills to about one-third to one-half full. To do this, what you want to do is you want to take those two tabs and open them, roll the pouch out three times, holding slightly upwards toward yourself. On the back of this pouch here are two Velcro dots that you can go ahead and connect.
And then when you pinch the sides, it kind of forms a funnel. And that way when you go into the bathroom, you can go ahead and empty the contents of the pouch and then take some dry toilet paper. You can rinse along the inner portion of the pouch, and then wipe on the outside of the pouch, and dispose of that in the toilet. And then go ahead and roll that back three times towards yourself. And then close the Velcro tabs.
Some patients prefer to sit on the toilet and kind of scoot a little bit farther back and lean forward to empty their pouch, while others may prefer to stand. If you prefer to stand to empty your pouch, I suggest you place some toilet paper in the toilet prior to emptying to prevent any type of splashback. Thank you, Debra, so much for being here today.
This should have given you a very good indication of how a person changes and empties their pouching system. Most people change their pouching system about every three to four days because the adhesive starts to wear at that time. So you should expect to change your pouch about twice a week. And remember, if you're emptying your pouch, when it's a third to a half full, which could be several times a day, about four to six. Thank you.
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