A stoma is a surgically made hole in the abdomen that allows body waste to be removed from the body directly through the end of the bowel into a collection bag (Healthdirect 2020; Cancer Council Victoria 2019).
When caring for a client who is living with a stoma, you may need to help them empty and change the stoma appliance. It is also crucial to be able to identify any red flags that require escalation of care.
Monitoring the Stoma
Upon examination, take note of the following:
The stoma should be pink or red, moist and shiny
Swelling may be present during the postoperative period but should decrease in size within six to eight weeks
Minor bleeding may occur but should stop when you apply light pressure to the area
The mucocutaneous junction (the border between the stoma and the abdominal skin) should be intact, with even, intermittent sutures in situ
The skin surrounding the stoma (peristomal skin) should be intact, healthy and look similar to the skin on the other side of the abdomen
Transient erythema (reddening of the skin) may occur after removing the appliance, but should not remain red or painful
The stoma should be protruding between 2 and 2.5 cm from the skin
The volume, colour and consistency of output should be monitored and documented.
(WACHS 2019)
The stoma should be pink or red, moist and shiny.
How to Empty the Stoma Appliance
The stoma appliance should be emptied when it is between ⅓ to ½ full.
Explain the procedure and obtain consent from the client
Ensure the client’s privacy and comfort
Perform hand hygiene
Gather all equipment required for the procedure
Don non-sterile gloves and PPE according to standard precautions
Place a waterproof protective sheet between the client and the stoma appliance
Locate an appropriate receptacle
Place a layer of toilet paper in the receptacle to prevent splashing
Pull the client’s clothes away from the stoma appliance
Hold the stoma appliance over the receptacle in a position that is comfortable for the client
Hold the stoma appliance facing upwards
Open the appliance
Pinch the opening of the drainage bag and unroll over the receptacle
Slowly lower the opening of the drainage bag into the receptacle and slide your hands down the appliance to push out the contents
Once all the contents have been emptied into the receptacle, wipe the inside and outside of the spout with toilet paper
Check the appliance for tears or holes and replace if necessary (see below)
Rinse the clamp if there is faeces on it
Apply pouch deodorant on the outside of the bag if required
Close the appliance
Dispose of equipment and PPE according to local policies and procedures
Perform hand hygiene
Ensure the client’s comfort.
(WACHS 2019; Fairview 2011)
How to Change the Stoma Appliance
The required frequency for changing a stoma appliance will depend on the client, but as a general guide:
Type of appliance
How often it should be changed
One-piece drainable
Every one to three days
Two-piece drainable
Base: Every three to five days
Pouch: Every day
One-piece closed
One to three times per day
Two-piece closed
Base: Every three to five days
Pouch: One to three times per day
(CHHS 2014)
Note: Never attempt to repair a leaking stoma appliance. Always replace it with a new one.
Explain the procedure and obtain consent from the client
Ensure the client’s privacy and comfort
Perform hand hygiene
Gather all equipment required for the procedure
Don non-sterile gloves and PPE according to standard precautions
Place a waterproof protective sheet between the client and the stoma appliance
Empty the stoma pouch if required (see above)
If you are using a two-piece appliance, remove the old stoma pouch by pressing down on the base and removing the pouch. To remove the base, gently press the peristomal skin using an adhesive remover wipe and peel from the top right corner.
Dispose of the old stoma appliance into an appropriate clinical waste bin
Remove gloves if soiled, perform hand hygiene and apply new gloves
Use warm tap water and a soft, disposable cloth or tissue to clean the stoma and peristomal skin (avoid soap as this can impair adhesion). Pat the area dry
Remove gloves
Perform hand hygiene
Apply clean gloves
Measure and trace the shape of the stoma onto the plastic backing of the new appliance base. Ensure you cut the base to the correct size (no more than 5 mm of peristomal skin left exposed)
Cut out the base with scissors
Remove the plastic backing from the base. This can be used as a template for the next appliance change.
Run your finger around the inside of the cut edge to smooth any sharp edges
Close and secure the outlet of the new pouch (if it is drainable)
Place the adhesive base of the new appliance at the base of the client’s stoma and then fit over the stoma
Gently run your fingers around the adhesive to create a firm seal
Attach the new stoma bag to the base plate (if using a two-piece appliance)
Secure the closure on the stoma bag (if using a drainable appliance)
Place a warm towel over the appliance and discourage the client from bending for 10 minutes
Dispose of equipment and PPE according to local policies and procedures
Perform hand hygiene
Ensure the client’s comfort
Document stoma observations and the appliance change.
(WACHS 2019; CHHS 2014)
When to Escalate Care
The following signs and symptoms require escalation of care to an appropriately qualified medical practitioner:
Pale, dark, dusky or black stoma
Excessive swelling
Bleeding
Disruption to the mucocutaneous junction
Dehiscence of the mucocutaneous junction
Extruding serosal tissue
Skin redness, erythema, rashes or irritation
Impaired skin integrity
Skin pain or tenderness
Retracted stoma (where the stoma slides back into the abdomen below skin level)
Prolapsed stoma (where the stoma slides out of the abdomen and protrudes more than 5 cm from skin level)
Infection
Parastomal hernia (wherein part of the bowel protrudes through the stoma)
Note: This article is intended as a guide only for non-clinical staff who are required to provide stoma care for home care clients and should not replace best-practice care. Always refer first to your organisation's policies and procedures on stoma care.
Finlay, B Sexton, H & McDonald, C 2018, ‘Care of Patients With Stomas in General Practice’, Australian Journal of General Practice, vol. 47, no. 6, viewed 15 June 2021, https://www1.racgp.org.au/ajgp/2018/june/stomas-in-gp
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