Bag Change Pictures (graphic images!)

I decided that I wanted to record an account of me changing my bag at least once before I get rid of it! I figured it could be a good memory for me (yeah right!) and a possible help to anyone who is going through the same surgery. While I was preparing for surgery, watching these videos really helped me know what to expect, what questions to ask, and helped desensitize me to the "ick-factor" involved with an ileostomy. By the time surgery came around, I had watched just about every ostomy video available on the internet and felt relatively prepared to tackle my own ileostomy.
The video that I took ended up not being great quality. The sound is very hard to hear since my bathroom fan was running and I was talking very quietly (first thing in the morning with a cold!). So, instead of posting the video, I extracted some stills that will hopefully show the process a little better. At some point, I may try to record again with better video/audio quality. Seeing video is much better than pictures! I also edited out any "output" from the shots, but you can see my stoma through most of the video. If you are squeamish and don't wish to see it, then don't scroll down :)

Before starting the bag change, I typically gather all my supplies on my counter in my bathroom (see previous bag change post). Occasionally, I don't have everything I need which results in a trip across the hall with my stoma hanging out!

First, I place a plastic grocery bag in my pants to both catch any output from my stoma (occasionally happens) and to use as a trash bag while changing the pouch.

Next I check my bag and skin barrier to make sure they fit together correctly. I use Hollister bags with the "Lock 'n Roll" closure. I have found that there is a small bit of extra material on the end of the pouch closure tail. I usually take a pair of scissors and carefully remove the extra flap. This helps make emptying the bag much easier and much cleaner!

Next, I close the bag and make sure that the bag and the skin barrier attach together correctly. I've never had one that didn't fit, but I always make sure!

Then, I take some small curved scissors and cut out the opening where my stoma will go in the skin barrier. I cut just outside the 1 inch line and this fits my stoma very nicely. After I cut the hole for the stoma, I typically take my index finger and rub it on the inside of the hole I just cut. The warmth from my hand does a nice job in smoothing out the cut surface and gets rid of any rough edges.

Once I cut out the opening, I begin the process of taking the pouch off. I start by pulling up the tape border on the very edge of the skin barrier. Once this is done, I peel the entire barrier off from top to bottom.

Next up, I use 4X4 Gauze that I've wet with warm water to clean off any output on my stoma and the surrounding skin. I also do my best to get any left over adhesive off using the gauze

TA DA! Here's Johnny!

After cleaning the stoma and skin, I usually check the fit of my skin barrier around the stoma. This used to be more important when my stoma was still changing size. However, it has stayed the same size for a few weeks, so now I'm fairly certain it will fit on the first try.

Next, I spend a good bit of time shaving the area around my stoma. I usually start with a regular razor, then use electric clippers to get closer to the stoma (sometimes I even use tweasers to get any stray hairs). My belly is VERY hairy, so if I didn't shave, there would be no chance for the skin barrier to adhere to my skin.

Once my skin is shaved and clean, I prepare the skin barrier (some people call it a wafer as well). I remove the plastic backing and pipe out a ring of paste around the opening in the skin barrier. This is not really paste, but is like caulking that helps fill in any gaps in your skin near the stoma. This way, there is no leakage of output onto my skin. 

After there is a nice "bead of caulk," I usually wet my finger with water and mold the paste around to flatten it out and fix and spots that were messed up. It is normally VERY sticky, but the water helps make sure it doesn't stick to my fingers. If one side ends up being thicker than the other, that is usually the side that ends up on the bottom side of my stoma, since that is the most likely place to have a leak.

Next, I set the skin barrier aside so the paste can set for a few minutes. While it is drying, I prepare the skin around my stoma. I use stoma powder layered with a skin prep wipe. The stoma powder removes any moisture from "weepy" or raw skin and the skin prep creates a film over my skin to reduce irritation from the adhesive or any output that may leak. I usually do two layers of each (powder, wipe, powder, wipe) always making sure to get rid of extra powder and making sure the skin prep has dried before moving on. 

Next, it is time to put on the skin barrier. If my stoma is not very active, I usually do the next few steps all in a row. I place the skin barrier over my stoma, remove the paper backing from the edges of the barrier, and then put the bag on. 

Always press around the inside of the plastic flange ring
to make sure you have a good seal.

Removing the paper backing.

While putting my bag on I usually fold it in half while pressing the flanges together. This is to make sure that no output, stoma powder, paste, or skin barrier gets on the bag. If any of this drips onto the grocery bag, there is potential for this to get on the pouch while clicking it into place. I avoid this by folding it in half and then clicking it into place. 

Lastly, I place my hands over the stoma and new skin barrier to activate the adhesive and make sure there is a good seal. The heat from my hands helps the adhesive stick better and results in a much better seal. I usually only do this for about 30 seconds or so. 

After this, I collect any remaining trash, tie up the grocery bag, and take it out to the trash can (outdoor trashcan!). All together, this all takes about 20-25 minutes for me. I am a perfectionist and I have had good luck with all my pouch changes. I've never had a true leak or "blowout" since surgery (I've had minor leaks just around the stoma, but not bad enough to change the pouch). All of my bag changes have been scheduled and I attribute this to my perfectionist approach to bag changes!

Please let me know if you have any questions about my bag change. I would be more than happy to help!