hey everyone is cereth register nurse sorry and calm and in this video i'm going to demonstrate how to change an ostomy pouching system in the previous video i did an in clicks review over colostomies and it we asked me so be sure to check out that video so first let's talk about the supplies you will need you will need a pouching system here I have a one piece pouching system and it has a skin barrier also called a wafer for land and it's attached to the pouch so it comes together and some people have the two-piece systems and the skin barrier and the pouch are separate and they snap on to each other whenever you're placing the system I'm also what you may need that I don't have right here you may need a barrier ring and the barrier ring will go around the stoma for extra protection in case the patient's having a lot of skin breakdown from still getting on to the skin and the skin barrier just isn't really protecting it so the barrier ring would go around the stoma and you would set the skin barrier on top it out and then also with this particular system we have a clip so be sure you get the clip if your patient needs one and some bags will velcro and that's how they close but this particular one uses a clip another thing you will need is a measuring card and these come in the kits usually and you will just be using it to measure the stoma because you will be cutting around your barrier what size the sum is so you can apply it to the skin so you'll need a pin you will also need some ostomies scissors these scissors are special and that they're curved and they have a blunt tip so you can achieve a circular cut instead of a jagged cut onto the barrier and of course you will need gloves you will need some wash cloths to clean the stoma and to dry it and it's how just to prevent any leakage of stool on to the patient first perform hand hygiene and then you will dawn gloves then give us how and place that on your patient to protect their gown and their skin from any soul by your change in the system and some things you want to keep in mind while doing this you'll want to change the system about every three to five days and you will empty the pouch whenever it becomes one-third to half way full and here as you can see this definitely needs to be empty but we're changing the system so it's good and and while you're doing this you want to allow the patient to help you as much as possible because they need to become independent in doing this because I'll be doing it whenever they go home now if you are a nurse who has a very sensitive nose and you're bothered by odorous smells and you need to be prepared for this because whenever you're changing an awesome e bag there are some pungent odors and to help with this you can maybe wear a mask I've even known some colleagues to put vapor rub around their nose before they go in to change the pouch to prevent the smell and so you can have a menthol smell and you notice you're changing it so just be aware of that and prepare beforehand so what we're going to do is we are going to remove the system and whenever you do this you want to do this when the gut is the least active because you don't want to be changing it and all the stool is just coming out on you because you're going to be making a huge mess so usually in the morning before breakfast before the patient eats is the best time or ask the patient because they'll know when there's some of hits off police but if this is a brand new summer that may not know so what you're going to do is you're just gently going to remove the adhesive because this is the one piece system and it has it's sticking to the skin and if you have difficulty removing it you can use some adhesive remover okay so we have that off and what you're going to do is just discard this appropriately then you're going to take your washcloth with warm water try not to use any soap have lotion powders creams or any alcohol containing products around the summer on the stoma because it caused some problems and before you do it you want to make sure you're looking around the stoma and looking for any skin breakdown like extreme redness now as you can see in this example there is redness around the stoma this is not good and what is happening is that stool is leaking probably under that skin barrier and getting on to the skin so whenever you're replacing the bear at the pouching system you may want to use a barrier ring and make sure that you're cutting the skin barrier should fit the stoma appropriately so it's not leaking onto the skin and what you'll do is you'll start around the skin and just gently clean the skin making sure to get any residue off and then you will clean your stoma and the stoma is not painful to the patient remember it's just the inside of the intestines flipped inside out so it's not painful for you to clean the stoma and make sure you have it all clean then you will Pat the area dry you want this to be very dry because if it's not dry your skin barrier is not going to stick to the skin hand firm if you have a patient who has a lot of hair on the abdomen because you know hair grows back you may want to trim the hair because number one it will stick better and when you remove next pouch change it's not going to wax or hair off which can be very painful so make sure you do that then discard your gloves and perform hand hygiene and put on a new pair of gloves now we're going to measure our stoma using our measuring card and the reason we want to do this is because we're going to be cutting a hole on our skin barrier and this is going to be going on the skin and we don't want to cut it too big we're still the leak to the skin or cut it too small where it will constrict the stoma so we want to measure appropriately and you'll take your measuring card you'll put it flush up against the skin and you want about a 1/8 inch an area around the stoma so this right here way too big and that is too big as well let's try this one and that one looks like it's perfect you have around the stoma about a 1/8 inch and look and see what it reads and it says 45 mil millimeters so we're going to match that up on our bag and trace it now some skin barriers are already labeled and they have a nice little outline of where your measurement is like here it already says 45 millimeters so I don't have to trace it but sometimes skin barriers don't have that so what you would have to do is put your measuring card over it and trace where you had your measurement so you was on the 45 millimeter and you would just create a circle on the barrier and then cut it out now I'm going to take my awesome scissors and I'm going to cut around the 45 millimeter mark and just go back through and make sure everything's nice and round and there's no jagged edges because you don't want this to wear on the stoma or on the patient's skin and we had it in looks good now let's put the new passing system on what I like to do is I like to snap my bag and make sure it's closed before I put it on just in case something leaks out so this is the clip like I said the beginning some velcro and these clips can be a little bit cumbersome to you so get familiar with how to use them what you do is you take the end of it the [ __ ] and you just simply fold it over the clip like so and then you just press that down and it snaps in place and you have your little clip on and then you will take the backing off of your skin barrier and if you're going to place a barrier ring now would be the time to do that so you place the barrier ring on around the stoma and then you would place your skin barrier your wafer flange on over the stoma and you want to make sure that it fits really good and that you smooth it around the sign so it's sticking to the skin appropriately and feels very good now some things you want to keep in mind if this is a new and awesome e for the patient you want to explain to them that they need to be checking their bags every so often because it can inflate with gas and they will need to do what's called burping their bag and to burp this particular bag you would take off this cliff and just let the air out now some awesome e bags do have a filter that allows the gas to escape and prevents an odorous smell from coming out so you just have to look to see what you have and just warn the patient that when they do relieve the gas from there that they may want to make sure that no one's around if someone's visiting them or something like that because it can produce an odorous smell and as the nurse you want to be checking this as well because our patients tend to wear those big bulky gowns and they can't include you being able to see the bags in plates so you'll have to pull the gown back and actually look at the bag so that is how you change an ostomy pouching system thank you so much for watching and don't forget to subscribe to our channel for more videos