Ostomy pouching options
Before we
discuss pouching options and accessories, let’s review the purpose of having a
pouching system:
It contains
effluent, gas & odor
It prevents
leakage & can help to ease embarrassment
It serves to
protect the peristomal skin, and
It assists the
patient in their return to their previous lifestyle.
Determination criteria:
Dietitians
Ostomy type
Characteristics of effluent
Topography of abdomen
Peristomal skin’s condition
Patient preference/fit
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There are several pouching options available
that can make
the reality of living with an ostomy easier. Let’s take a look at a few of them.
All of the options we are going to talk about have to do with disposable ostomy
bags.
However, reusable bags are available. Only rarely are patients encountered who
currently use or want to use reusable ostomy supplies, but they are out there.
Should a patient be encountered that uses reusable products, it is best to
consult with a wound and ostomy care nurse, or the product manufacturer, on the
best options for care.
Disposable systems utilize a pouch
(either clear or opaque) to collect the effluent with either a 1-piece pouch, or
2-piece pouch with skin barrier (or wafer), to protect the skin. It is usually
recommended that new ostomy patients use a clear bag at first to help with bag
changes. This slide shows an example of a 2-piece system on the left and a
1-piece on the right.
Skin barriers
may be made from pectin, carboxymethylcellulose, karaya or an extended wear
polymer. Beside the wafer, skin barriers are available in ring, powder and paste
formulations. In the initial post-op period, a clear pouch is preferred to
facilitate the required frequent stomal assessments, as well as the use of a
cut-to-fit skin barrier to accommodate the changing stoma size as the post-op
swelling decreases. It is usually easier for patients to center the skin barrier
or wafer around the stoma when a 2-piece system is used, enabling the patient to
change the pouch without disturbing the skin barrier.
Disposable/Reusable
One-Piece/Two-Piece
Clear/Opaque
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Pouches are also available with pre-cut skin barriers for ease of use. They can
also be purchased with cut-to-fit barriers for a more custom fit.
One-piece pouches are available with either option, and for patients who like a
2-piece system, the same options apply.
Generally,
patients with an uncomplicated stoma and peristomal surface may elect to use a
pre-cut skin barrier or wafer. Whether the patient uses cut-to-fit or pre-cut,
the size should be no more than 1/8” larger than the diameter of the stoma
itself.
Cut
to fit/precut
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In order to
achieve the best seal possible, pouches and barriers come with flat or curved
(called convex) skin barriers. This allows for the best possible surface seal
that eliminates leakage. Several factors determine which type of barrier to use,
but generally speaking patients who have flush or retracted stomas, or bellies
with more fat, folds or scars will want a convex skin barrier, while flat
bellies will work best with a flat barrier. Convexity also helps to pop the
stoma up by depressing the peristomal skin, and improves wear-time by decreasing
problems associated with effluent seeping out from under the skin barrier. An
ostomy belt can also be worn to increase convexity and support.
This slide shows
both types of barriers—as part of a 1-piece pouch, or just the skin barriers for
use in a 2-piece system. For more pictures of the many options available, visit
one of the ostomy supply company’s websites.
Drainable/Non-drainable
Flat/Convex
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