Teaching for all new ostomy patients

There are many things the nurse needs to teach a new ostomy patient when they come home from the hospital. There are seven main points that need to be covered, so let's break this next section down in order to make it easier to digest.

1. The first thing the caregiver should do is to make sure their patient knows how to empty their one-piece bag. For colostomy and ileostomy patients, they need to sit all the way back on the toilet, separate their legs and then open the end of the pouch and empty it. The bag should be emptied when it is 1/3 to 1/2 full.

2. They then need to clean the end of the bag with toilet paper or wipes. Wipe the inside edge of the bag and outer edge until completely clean and then either roll it back up or clamp it (depending upon the type of bag being used).

3. Teach your patient how to measure their stoma each time they change the flange (for at least the first 2 months). Stomas are quite swollen when they are newly formed and will shrink over the next 2 months. The flange should fit around the stoma allowing about 1/16 to 1/8 of an inch of space. Using a measuring guide that comes in the box of flanges, measure both the length and width of the stoma. Then using those markings, draw a circle on the back of the flange and have the patient cut it out. If the patient has a round stoma, they will quickly be able to go to a precut flange. If their stoma remains oval, they will need to continue to cut the flange, or possibly use a moldable wafer.

4. Clean the skin around the stoma with water and paper towels, or a washcloth. You do not need to use soap or any other special cleaners.

5. When patients first come home from the hospital they generally change their flange 2 times per week. They need to be measuring their stoma and re-sizing the opening during each change. They also need to continually assess their skin for any complications. The frequency of flange changes from then on is based on the individual needs of the patient. Some patients have great stomas with no leaking or skin issues. These patients can leave the flange on for up to a week if they choose. For others, who have very difficult stomas, they may need to change their appliance every other day in order for it to not leak or cause skin irritation.

6. Teach your patients how to use any needed accessories. The general rule is to use the least amount of product needed. If someone is able to use an appliance with no accessories and they have no leaking or skin issues, they should be encouraged to continue to do so. For others, daily use of powder/prep for skin irritation, rings for better adherence, belts to hold the flange down more securely may be their routine.  Once again, these are VERY individual choices based on each individual patient.

7. If the patient has a hairy abdomen, have them shave once a week. They should preferably use an electric razor to prevent damage to the skin or stoma.  If they use a straight razor have them use shaving cream and start at the stoma and move outward--never towards the stoma.

On the very first visit after a patient comes home from the hospital it is best for the nurse to demonstrate all of the various aspects of their ostomy care, teaching each step as they do it. It is just common sense, but not obvious to the new stoma patient, to have all equipment open and ready to use prior to removing the old appliance. After this you should have the patient participate in the ostomy care during each visit. If the patient is unable to change the ostomy independently (for instance due to a physical or cognitive limitation), then have the caregiver perform the ostomy appliance change with cuing from the nurse at each step. Prior to the patient’s discharge from Home Care, the patient/caregiver should be able to change the ostomy appliance independently.