How to Change Your Urostomy Pouching System in the Hospital

This video will show you how to change your urostomy pouching system while you're in the hospital.

Your pouching system includes a wafer, which is the part that sticks to your skin, and a pouch that holds your urine.

In the hospital, most people use a 2-piece pouching system and a low-pressure adapter. With a 2-piece system, the wafer and pouch are separate.

You should change your pouching system about every three days. It's best to change it in the morning before you drink anything, when there's less urine coming out of your stoma.

Change your pouching system right away if it's leaking.

You will be in the hospital bed the first few times you change your pouching system. Your nurse will help you. Once you're comfortable standing up for 15 to 20 minutes, you can change your pouching system wherever you're most comfortable. Most people like to change it in the bathroom in front of the mirror.

Before you start, your nurse will bring your supplies. You'll need adhesive remover spray, dry gauze, gauze moistened with warm tap water, a measuring guide, a pen or marker, scissors if you're using a cut-to-fit wafer, a new wafer, pouch, and low-pressure adapter, and a small mirror.

They will also bring any extra supplies you're using, such as ostomy powder, skin prep wipes, a barrier ring, elastic barrier strips, or urostomy belt.

Once you have your supplies, clean your hands with an alcohol-based hand sanitizer or soap and water.

First, you'll need to disconnect the pouch from the night bag. Look at the spout on the bottom of your pouch. You will see a tab with a red line. The red line means the spout is open and urine can run out of the pouch.

You can use the phrase "red means running" to help you remember.

To close the spout, flip the tab so the white side is showing. Pinch the sides of the night bag adapter. Pull it down and away from the spout. Then, put the cap on the spout. Clean your hands.

After you disconnect the pouch from the night bag, you can take your pouching system off. You will remove the wafer and pouch together.

The skin around your stoma is sensitive, and it's important to be gentle. Don't pull the wafer straight away from your skin.

First, spray the adhesive remover over the wafer. Press down on your skin with one hand. With your other hand, gently lift an edge of the wafer and pull the wafer down and away from your skin. Spray more adhesive remover spray underneath the wafer as you go.

Once you've removed the pouching system, throw it in the trash.

Hold a piece of dry gauze over the opening of your stoma to keep urine from leaking out. Change the gauze if it gets soaked with urine.

Next, use the moistened gauze to gently clean the skin around your stoma. Don't use any soap. Pat your skin dry with a piece of dry gauze.

While you're doing this, look at the color of your stoma and the skin around it. Your stoma should be pink or red, like the color inside your mouth. If it's any other color, like brown, gray, or black, tell your nurse.

You will have one or more tubes coming from the opening in your stoma. These tubes will be taken out right before you go home or at your first appointment after surgery.

After you finish cleaning and drying the skin around your stoma, use the measuring guide to measure your stoma and fit the wafer. To do this, compare the holes in the measuring guide to the size of your stoma. Choose the hole that fits comfortably around your stoma.

Trace the outline of this hole onto the back of the wafer. The back is the side that will go against your skin.

After you trace the outline, cut or mold the wafer to the size you need. While you're in the hospital, it's best to cut or mold just outside of the outline. This will give your stoma extra room in case it swells a little. If you're using a cut-to-fit wafer, remember to start cutting at the center hole.

If you're using a moldable wafer, turn the wafer over so you're looking at the front. The front is the side that will face away from your skin. Gently roll back the opening and press down for a few seconds to keep it from rolling back too much.

Check the wafer against your stoma to make sure it's the right size.

Next, break the inner lining on the pouch to make room for the tubes in your stoma. You won't need to do this once the tubes are removed.

Once the wafer and pouch are ready, snap the low-pressure adapter onto the wafer. Then, snap the pouch onto the adapter.

Always double-check that the pouching system is snapped together all the way. You can give it a small tug to make sure.

If you're using a cut-to-fit wafer, peel the smaller backing from the center of the wafer. Leave the backing around the edges in place.

If you're using a moldable wafer, peel the large backing from the wafer. Leave the smaller backing around the edges in place.

If you're using a barrier ring, peel the backing from both sides. Stretch the ring so it matches the size of the opening in your wafer. Press it onto the back of the wafer.

You can make tabs on the wafer's backing to make it easier to remove, but don't take it off yet.

Set the pouching system aside with the sticky side up.

Clean and dry the skin around your stoma the same way you did before. Gently fan the area with your hand until it's completely dry. The skin shouldn't be sticky.

If the skin around your stoma is irritated or very red, put a small amount of ostomy powder onto the irritated skin. Spread the powder with your fingers. Then, dab the powder with a skin prep wipe. This will seal the powder over your skin.

Let the powder dry for at least one minute. Fan the area to help it dry.

Place the pouching system over your stoma without removing the backing. Make sure the wafer is against your skin at the base of your stoma.

Place your hand over the wafer for three to five minutes. The warmth of your hand will help the wafer stick to your skin.

After five minutes, peel off the backing and press the wafer against your skin.

Take the cap off the spout at the bottom of the pouch. Push the adapter on the night bag onto the spout until you hear a click. Give it a small tug to make sure it's attached.

Open the spout by turning the tab so you see the red line.

If you're using elastic barrier strips, peel the backing from strips and put the barrier strips over the wafer close to the center. It's okay if a small part is on your skin, but try not to have too much on your skin. This can cause irritation.

If you're using a urostomy belt, hook it to the tabs on the left and right sides of the pouching system. Hook the belt to one tab, wrap it around your waist, and hook it to the other tab. Adjust it so it fits snugly.

Clean your hands with an alcohol-based hand sanitizer or soap and water.

You're now finished changing your pouching system.

As a reminder, the steps to change your pouching system are: gather your supplies, disconnect the pouch from the night bag, take the pouching system off, clean the skin around your stoma, get the new pouching system ready, put the new pouching system on, and reconnect the night bag.

If you have any questions about your urostomy or urostomy pouching system, you can find more resources on our website. Go to www.mskcc.org/pe and search for urostomy. You can also ask your nurse.