What is a stoma?
The word “stoma” comes from the Greek word meaning “mouth”.
Formation of a stoma includes a surgical procedure to create an opening on the abdomen where the bowel is brought out onto the surface of the skin on the abdomen.
The two most common stomas are:
- Colostomy; part of the large bowel/colon brought to skin level.
- Ileostomy; part of the small bowel /ileum brought to skin level.
Some children can have two openings brought to the skin level. The active (proximal) stoma will produce stool (poo). The non-active (distal) stoma goes down to where the anus should be. This is called a mucus fistula, it may or may not produce mucous.
Step by step procedure to change a one piece stoma bag
What you will need
- Warm tap water and bowl (no soap)
- Dry wipes for washing and drying
- Stoma scissors
- Stoma appliance (1 piece)
- Disposable waste bag
- Adhesive remover spray
This photograph shows the equipment needed to change a one piece stoma bag
Procedure
- Wash your hands correctly using soap and water. Prepare your equipment. Fill bowl with water, get dry wipes out ready for use. Get baseplate and baseplate template with stoma scissors out for use. Get disposable waste bag ready for use.
- If the patient’s stoma bag is full, open the drainable end and empty the contents of the stoma bag into a disposable waste bag/bowl or stand over a toilet and drain into toilet basin.
- Begin to remove the stoma pouch using the adhesive remover spray to lift the flange off the skin. Place this in the disposable waste bag.
- Adding warm tap water to the bowl, wet a dry wipe to clean the stoma. Once the stoma and surrounding skin is clean place a dry wipe over the top of stoma to keep it clean. This is a good point to assess the stoma, it should be pink, wet and active.
- Check the size of the stoma using the baseplate from previous change. This helps to ensure you will cut the new baseplate to fit snugly around the stoma and adhere to the skin. There should be no skin seen around the hole of the template.
- Place the template over the back of the new baseplate which will be sited and, using a pen draw a circle. Cut this out using the curved scissors. Warm the baseplate between your hands to help adherence to abdomen. See below:
- You are now ready to place the pouch on the abdomen over the stoma. Start by patting surrounding skin dry. It is important that surrounding skin is dry before applying the new pouch.
- Remove protective covering from the baseplate immediately before application. This will provide you with a template for the next time you need to cut the flange. Apply baseplate/pouch to cover the stoma and stick to abdomen. The stoma bag should always be pointing downwards to drain stool.
- Ensure the stoma pouch is fitting well by placing your hand over the stoma bag to help it adhere to abdomen.
- If using a drainable pouch ensure the bottom of the bag is closed to avoid leakage.
Problems you may see with the stoma
Retraction/stenosis This is where the stoma may be flat to the abdomen. If it is pink and active this may not be a cause for concern, but please contact your nurse for advice.
Prolapse A prolapse is where the stoma can extend in length. Usually the stoma will return to its normal size and remain pink. If it does not and the stoma becomes dark and discoloured contact your nurse for advice.
Bleeding The bowel has an excellent blood supply. When the bowel is touched i.e. when cleaning the stoma end, a small amount of blood will be seen, this is normal. If blood is seen in the stool or inside the bag please contact your nurse for advice.
Sore skin Check appliance, always cut flush to the stoma leaving all skin protected. The skin is protected by the baseplate of the stoma bag. If stool leaks underneath the baseplate the skin will become sore. Please ensure the stoma appliance is checked to ensure it is fitting correctly around the stoma. Please contact your nurse for advice on suitable products to help skin recover.
Teaching plan
Skill to be attained
- Parents / Carers have observed changing the stoma bag.
- Parents / Carers can correctly identify equipment necessary to change stoma bag.
- Parents / Carers have removed appliance and cleaned the skin.
- Parents / Carers have cut and applied a new stoma bag with supervision.
- Parents / Carers have performed total stoma care without nursing supervision.
- Parents / Carers have been warned about prolapse, inversion and bleeding.
Re-ordering supplies
Your Colorectal nurse will order your first delivery of stoma supplies. You will receive stoma bags, dry wipes, wet wipes, waste bags and any accessory products as necessary.
It is your responsibility to make sure all future orders are placed so you receive the order before you run out of supplies.
Discharge
Please inform the Children’s Colorectal Nurse when you are discharged.
