Name: Date:

Course: Signature:

Instructor/ Evaluator: Dr. Jun Paras Basto Score:

Needs Practice Changing and Emptying an Ostomy Appliance

Satisfactory
Excellent

Goal: The stoma appliance is applied correctly to the skin to allow

stool to drain freely. Comments
1.0 0.5 0
1. Bring necessary equipment to the bedside stand or overbed
table.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Close curtains around bed and close the door to the room, if
possible. Explain what you are going to do and why you are
going to do it to the patient. Encourage the patient to observe
or participate, if possible.
5. Assist patient to a comfortable sitting or lying position in bed
or a standing or sitting position in the bathroom.

Emptying an Appliance
6. Put on disposable gloves. Remove clamp and fold end of
pouch upward like a cuff.
7. Empty contents into bedpan, toilet, or measuring device.
8. Wipe the lower 2 inches of the appliance or pouch with toilet
tissue.
9. Uncuff edge of appliance or pouch and apply clip or clamp, or
secure Velcro closure. Ensure the curve of the clamp follows
the curve of the patient’s body. Remove gloves. Assist patient
to a comfortable position.
10. If appliance is not to be changed, remove additional PPE, if
used. Perform hand hygiene.

Changing an Appliance
11. Place a disposable pad on the work surface. Set up the wash
basin with warm water and the rest of the supplies. Place a
trash bag within reach.
12. Put on clean gloves. Place waterproof pad under the patient
at the stoma site. Empty the appliance as described
previously.
13. Gently remove pouch faceplate from skin by pushing skin
from appliance rather than pulling appliance from skin. Start
at the top of the appliance, while keeping the abdominal skin
taut. Apply a silicone-based adhesive remover by spraying or
 wiping with the remover wipe. Push the skin from the
appliance rather than pulling the appliance from the skin.
14. Place the appliance in the trash bag, if disposable. If
reusable, set aside to wash in lukewarm soap and water and
allow to air dry after the new appliance is in place.
15. Use toilet tissue to remove any excess stool from stoma.
Cover stoma with gauze pad. Clean skin around stoma with
mild soap and water or a cleansing agent and a washcloth.
Remove all old adhesive from skin; use an adhesive remover,
as necessary. Do not apply lotion to peristomal area.
16. Gently pat area dry. Make sure skin around stoma is
thoroughly dry. Assess stoma and condition of surrounding
skin.
17. Apply skin protectant to a 2-inch (5 cm) radius around the
stoma, and allow it to dry completely, which takes about 30
seconds.
18. Lift the gauze squares for a moment and measure the stoma
opening, using the measurement guide. Replace the gauze.
Trace the same-size opening on the back center of the
appliance. Cut the opening 1/8 inch larger than the stoma
size.
19. Remove the backing from the appliance. Quickly remove the
gauze squares and ease the appliance over the stoma.
Gently press onto the skin while smoothing over the surface.
Apply gentle pressure to appliance for 5 minutes.
20. Close bottom of appliance or pouch by folding the end
upward and using the clamp or clip that comes with the
product, or secure Velcro closure. Ensure the curve of the
clamp follows the curve of the patient’s body.
21. Remove gloves. Assist the patient to a comfortable position.
Cover the patient with bed linens. Place the bed in the lowest
position.
22. Put on clean gloves. Remove or discard equipment and
assess patient’s response to procedure.
23. Remove gloves and additional PPE, if used. Perform hand
hygiene.
TOTAL
Name: Date:
Course: Signature:

Instructor/ Evaluator: Dr. Jun Paras Basto Score:

Needs Practice Irrigating a Colostomy

Satisfactory
Excellent

Goal: The patient expels soft, formed stool. Comments

1.0 0.5 0
1. Verify the order for the irrigation. Bring necessary equipment
to the bedside stand or overbed table.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Close curtains around bed and close the door to the room, if
possible. Explain what you are going to do and why you are
going to do it to the patient. Plan where the patient will
receive irrigation. Assist patient onto bedside commode or
into nearby bathroom.
5. Warm solution in amount ordered and check temperature
with a bath thermometer, if available. If bath thermometer is
not available, warm to room temperature or slightly higher,
and test on inner wrist. If tap water is used, adjust
temperature as it flows from faucet.
6. Add irrigation solution to container. Release clamp and allow
fluid to progress through tube before reclamping.
7. Hang container so that bottom of bag will be at patient’s
shoulder level when seated.
8. Put on nonsterile gloves.
9. Remove ostomy appliance and attach irrigation sleeve. Place
drainage end into toilet bowl or commode.
10. Lubricate end of cone with water-soluble lubricant.
11. Insert the cone into the stoma. Introduce solution slowly over
a period of 5 to 6 minutes. Hold cone and tubing (or if patient
is able, allow patient to hold) all the time that solution is being
instilled. Control rate of flow by closing or opening the clamp.
12. Hold cone in place for an additional 10 seconds after the
fluid is infused.
13. Remove cone. Patient should remain seated on toilet or
bedside commode.
14. After majority of solution has returned, allow patient to clip
(close) bottom of irrigating sleeve and continue with daily
activities.
15. After solution has stopped flowing from stoma, put on clean
gloves. Remove irrigating sleeve and cleanse skin around
stoma opening with mild soap and water. Gently pat
peristomal skin dry.
16. Attach new appliance to stoma or stoma cover
17. Remove gloves. Return the patient to a comfortable position.
Make sure the linens under the patient are dry, if appropriate.
Ensure that the patient is covered.
18. Raise side rail. Lower bed height and adjust head of bed to a
comfortable position, as necessary.
19. Remove gloves and additional PPE, if used. Perform hand
hygiene.
TOTAL