The Changing of the Bag

Today, I changed my bag at home for the first time. I've had the home health nurse change the bag once and the ostomy nurse at the hospital changed it on Monday of this week. This, however, was the first time that I did all the steps by myself. I did have a home health nurse here to help in case I needed it, but I was basically able to do it all on my own. Here's what a bag change entails (in my case at least):

My pouch changing supplies
(From left to right) Hollister Wafer, 3M Barrier Wipe, Hollister Pouch
Stoma Paste, Stoma Powder, Scissors

First, I collected all my materials and place them on my bathroom counter. Today, I tried something that I found on YouTube... While changing the bag, I placed a grocery bag in my pants to act not only as a trash bag for all the trash, but also it was there in case things started happening (I hadn't eaten yet, but there was still a very small amount of "output"). I found this worked very well and will continue to use the grocery bag as I go on.

Next, I removed the old bag. This requires slowly peeling the tape border of the wafer away from my skin. Then, the inner layer of adhesive is removed from the top down to the bottom. Once the adhesive is off, the bag can be thrown away (in my trusty grocery bag) and my stoma is free! I assessed my stoma (still nice and red) and the skin around the stoma (peristomal skin if you want the technical term). My skin was a little red, but I think it was mostly because the adhesive tugged at my skin as I removed it. There are still two spots where the rod holding the ileostomy in place were sutured. One is healing nicely since it is located further from the stoma and can breathe a little bit through the tape border of the wafer. The other spot is not healing quite as nicely since it is located closer to the stoma where the adhesive is stronger and not breathable (I may have to have the stoma nurses look at this if it doesn't look better next time... not sure what the solution might be). After cleaning off the stoma and wiping the  peristomal skin clean with a wet rag, I applied a little bit of stoma powder to these two spots. This powder is supposed to absorb moisture and help them heal. After applying the powder, I wiped off the extra and then dabbed each spot with no-sting barrier wipes. These wipes are alcohol free and provide a barrier to protect the skin from the adhesive. After allowing this to dry, it was time to apply the new wafer and pouch.

I had already measured my stoma and cut the opening in the wafer to fit around my stoma. My stoma is about 1 1/4" around (which is about the same as it has been each time I've changed the bag). After measuring and cutting, I then applied "stoma paste" to the back of the wafer at the edge of the hole I cut out. This "paste" is not really an adhesive, but more like caulking that provides extra protection from leaks... it basically helps make sure that none of my stool seeps out onto my skin.

Finally, the last few steps are easy. I place the wafer around my stoma, ensure a good seal with the stoma paste, then press down to make sure the adhesive seals well. Then, I clip the actual bag in place using the tupperware-like seal (it snaps twice so that I know it's locked in place). Finally, I remove the backing from the tape border and adhere the border to my skin. After cleaning up my supplies and trash, I then use my hand placed over the new wafer to provide body heat that helps activate the adhesive and ensures a really good seal.

This may seem like a lot, but it only took about 15 minutes. I have been assured that I will get better as I do this more often and it will take less time as I get more practice. Overall, I was a little nervous about changing the bag myself, but it really was too bad. I certainly gained a little bit of confidence doing this on my own for the first time. One thing that the nurse recommended is using 4X4 gauze to wipe and clean the stoma. I have been using some cheap white rags that my mom bought after surgery. The idea is that I can wash them with bleach and always have some rags handy. Plus, the stoma nurses in the hospital used rags, so it was what seemed comfortable to us right after surgery. However, I think I may take the nurses advice. It seems a little easier to use the gauze instead of having to worry about the hassle of washing the rags every so often.