Changing Your Two-Piece Disposable Urostomy Appliance

This information will help you care for your two-piece disposable urostomy appliance.

Changing Your Appliance

You will need to change your appliance every 3 to 4 days.

  1. Gather your supplies. You will need:
    • Warm water
    • Unsterile 4x4 gauze
    • Measuring guide
    • New wafer
    • New pouch
    • Scissors (if non-moldable)
       
    • Pen or marker
    • Adhesive remover (spray or wipe)
    • Paper towel or wash cloth
    • Plastic bag
    • Mirror (for a better view of your movements)
  2. Clean your hands. To wash your hands with soap and water, wet your hands, apply soap, rub them together thoroughly for 15 seconds, then rinse. Dry your hands with a disposable towel, and use that same towel to turn off the faucet. If you’re using an alcohol-based hand sanitizer, cover all of your hands with it, rubbing them together until they’re dry.
  3. Open the closure at the bottom of your old pouch. Empty any urine from the pouch into the toilet.
  4. Close the pouch by flipping the spout.
  5. Stand in front of a mirror while removing your old appliance. Gently remove the old wafer with the pouch attached. If the old wafer is hard to remove, use adhesive remover or warm water on gauze to help break the sticky seal as you gently pull the wafer off your skin. Place the old wafer in a plastic bag and throw it away.
  6. Place a gauze directly over your stoma opening. This will prevent urine from leaking while you are changing the pouch. Change the gauze as it becomes soaked with urine.
  7. Measure your stoma size using the measuring guide made for you. If your stoma is not round, measure the vertical side and then the horizontal side, around the edges of your stoma. Be sure to add an extra 1/8 inch around the sides after measuring your stoma.
    • You will need to measure your stoma for about 6 to 8 weeks because it will slowly shrink. After this time, you can buy the wafers pre-cut or prepare them in advance. Some companies will charge extra to pre-cut. You can also buy your own cutter.
  8. Trace the outline on the back of the wafer, then cut the wafer or mold the wafer to the size you need.
  9. Cut out the pattern on the new wafer (see Figure 1). If you wish, snap the wafer and pouch together. If you have a moldable wafer, mold it to the exact size of your stoma; there should be no gaps. Do not cut a moldable wafer. If your pouch is clear, pre-snap the wafer to the pouch and give it a small tug to be sure it’s secure, then close it. If you’re using an opaque pouch, which is usually beige or grey, place the wafer first, then snap the pouch to your wafer.
    Figure 1. Cut the wafer
             
    Figure 2. Removing the backing
  10. Remove the inner paper on the new wafer (see Figure 2). You can fold back the outer paper as shown, but do not remove the outer paper at this time. Set the wafer aside with the sticky side up.
  11. Clean the skin around your stoma with warm water.
  12. Dry your skin thoroughly. If your skin around the stoma is irritated, see the section “Caring for Irritated Skin” in this resource.
  13. Fan the area dry or use a blow dryer on a cool setting until it is completely dry. Your skin should not be sticky.
  14. If you have snapped the wafer and pouch together, apply over your stoma. Place your hand over the appliance for 3 to 5 minutes, and then remove the outer paper and place on skin. If you have not snapped the wafer and pouch together, center the wafer around your stoma and apply it. Press the new wafer firmly to your skin. Make sure you seal the area directly around the stoma (see Figure 3).
    Figure 3. Press the wafer firmly
    Figure 4. Attach the pouch
  15. Attach the pouch to the plastic rim on the wafer if you haven’t already (see Figure 4). Align the plastic rim of the wafer. Starting at the bottom of the rim, gently apply pressure around the rim. You will hear and feel several snaps when the pouch is secure on the rim. Hold the wafer with 1 hand and gently tug on the pouch to make sure it is snapped securely.
  16. Secure the bottom closure of the pouch.
  17. If urine leaks on your skin before the new wafer is in place, you must clean your skin again by following steps 10 through 12.
  18. Lift the pouch on the left and right sides and underneath to check for any wetness or leaking.
  19. Clean your hands following the instructions in step 2.
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Caring for Your Irritated Skin

  1. Remove your appliance. Clean your skin with water and pat dry.
  2. Measure the size of your stoma again. Use the measuring guide that was made for you. Remember to fit around the edge of the stoma, so measure the vertical then the horizontal sides. Adjust the size of the opening, if needed.
  3. When you leave the hospital, your nurse will give you Stomahesive® powder to help with your irritated skin. Apply a thin layer the powder to your irritated skin. Dust off the extra powder by brushing lightly with a gauze pad. This is called the “crusting technique.”
  4. Pat the area with Skin Barrier®  to help protect the area and seal in the powder. This will also be given to you by your nurse. Allow it to dry for about 1 minute.
  5. Put the new appliance over your stoma. Make sure to use the new wafer that you measured.
  6. If your skin has not healed in 1 week, contact your Wound, Ostomy, and Continence (WOC) nurse or your doctor.
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Showering

You may shower daily with the pouch and wafer in place. Don’t use perfumed or oil-based soaps around your stoma.

Ask your WOC nurse for tips about using shower protectors. Some people have found them helpful in protecting the wafer.

On the day you change your pouch, you may remove your wafer and pouch before you shower. Urine will continue to flow from your pouch while you shower.

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Home Care of Your Night Drainage Equipment

  1. Tape the connections between the pouch and night drainage bag, if you wish. Use a leg stabilizer or Foley® catheter holder if you move around a lot while you sleep.
  2. Each morning, empty the urine from the drainage bag into the toilet.
  3. Rinse the drainage bag and tubing with a solution of 1/4 cup white vinegar and 3/4 cup water. Allow the bag and tubing to air dry.
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Ordering Supplies

Order more supplies when you have only 1 box of pouches left. You can order from 1 of the following distributors:

 

Edgepark
800-321-0591

Byram
877-902-9726

   

Liberty
800-357-4619

McKesson
800-451-6510

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Prepare an Emergency Kit

  • Prepare a small emergency kit with a pre-cut wafer, a pouch, and several gauze pads.
  • Have this kit with you at all times in case your pouch leaks.
  • Protect your kit from direct sunlight or heat.
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Traveling with Your Appliance

Your travel decisions should not be based on the fact that you have a stoma. Here are some tips to help you manage traveling with your appliance:

  • Take extra supplies with you in case you have trouble getting them while you’re away.
  • Carry all your equipment with you. Don’t check it on the plane or train. There is always the chance you may become separated from your luggage.
  • Avoid driving a car for 4 to 6 weeks unless your doctor tells you otherwise. You may wear a seat belt loosely or place a small pillow over your stoma and under your seat belt. There is also the Freedom Belt® for ostomates. Check with your distributor or ask your nurse about the belt.
  • You can use a leg bag if you think you may have trouble getting to a toilet to empty your bag.
  • If you’re traveling by airplane, you may want to get a travel card from the United Ostomy Associations of America (UOAA) by visiting  www.ostomy.org/uploaded/files/travel_card/Travel_Communication_Card.pdf.

For more information, visit the UOAA webpage at www.ostomy.org or call 800-826-0826.

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