21.15 Checklist for Ostomy Appliance Change

Use the checklist below to review the steps for completion of  an “Ostomy Appliance Change.”

Steps

Disclaimer: Always review and follow agency policy regarding this specific skill.

1. Gather supplies: washcloth and warm water, stoma products/appliances per order/patient preference (wafer, bag, clip), sizing measures, scissors, pen, nonsterile gloves, skin prep or other skin products per patient preference, and wastebasket.
2. Perform safety steps:
   • Perform hand hygiene.
   • Check the room for transmission-based precautions.
   • Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
   • Confirm patient ID using two patient identifiers (e.g., name and date of birth).
   • Explain the process to the patient.
   • Be organized and systematic.
   • Use appropriate listening and questioning skills.
   • Listen and attend to patient cues.
   • Ensure the patient’s privacy and dignity.
   • Assess ABCs.
3. Set the bed to a comfortable height; raise the opposite side rail.
4. Ask the patient about preferences, usual practices, care, and maintenance at home.
5. Apply nonsterile gloves.
6. Position the patient according to patient status:
   • Assist the patient to the bathroom and have him/her sit on the toilet to be near the sink for ease of process.
   • If in bed, uncover the patient, exposing only the abdomen. Apply drape/chux under the patient or ostomy pouch. Place the wastebasket near the bed.
7. Empty the pouch depending on the type of the appliance and the location type of procedure:
   • Remove the pouch and empty it into the toilet.
   • Set pouch aside in the basin or receptacle if at bedside.
   • Assess ostomy bag contents, and remove current ostomy appliance (keep clamp if present).
8. Remove adhesive residue from the skin with adhesive remover wipes.
9. Cleanse the stoma and surrounding skin with gauze and room temperature tap water; pat dry the skin.
10. Assess the condition of the stoma and peristomal skin.
11. Place the gauze pad over the stoma while you are preparing the new wafer and pouch.
12. Trace the pattern onto the paper backing of the wafer and cut the wafer. No more than 1/8 inch of skin around the stoma should be exposed for correct fit.
13. Apply skin prep and wait until tacky (optional).
14. Remove the gauze pad from the orifice of the stoma.
15. Remove the paper backing from the wafer and place it on the skin with the stoma centered in the cutout opening of the wafer; press gently on the wafer to remove air/seal to the skin.
16. Apply pouch to wafer with clamp on pouch and opening in downward position.
17. Attach and close the pouch clamp.
18. Dispose of old supplies and wrappings.
19. Remove your gloves and perform hand hygiene.
20. Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.
21. Ensure safety measures when leaving the room:
    • CALL LIGHT: Within reach
    • BED: Low and locked (in lowest position and brakes on)
    • SIDE RAILS: Secured
    • TABLE: Within reach
    • ROOM: Risk-free for falls (scan room and clear any obstacles)
22. Document the procedure and related assessment findings. Report any concerns according to agency policy.