[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Procedures](https://durgical.com/en/nursing/areas/procedures/) › Ostomy care: changing the pouch and assessing the stoma # Ostomy care: changing the pouch and assessing the stoma - Procedure Measure the stoma, cut the barrier just larger, and check that the stoma stays pink, moist and does not change colour. Updated Nov 5, 2026 ## Key points - Healthy stoma: moist, pink or red. Report if it is pale, purple, bluish, black, dry, very swollen or has a foul discharge. - Measure the stoma with the guide and cut the barrier about 2 to 3 mm larger than the stoma. - Clean the stoma and skin with warm water, no harsh soaps, and dry well before applying. - Change the system if it leaks or smells, if skin is exposed, or if there is itching or burning under the barrier. - Empty the pouch before it fills: a urostomy pouch when it is a third full. ## What it is An elimination ostomy is an opening on the abdomen (stoma) connected to the bowel or the urinary tract. In an ileostomy the ileum is brought out, in a colostomy the colon, and in a urostomy the ureters. The stoma has no sensation and the patient cannot control its output, so it is collected in a pouch stuck to the skin with an adhesive barrier. A healthy stoma is moist and pink or red; after surgery it is swollen and shrinks over the following weeks. Ostomy care protects the surrounding skin, prevents leaks and prepares the patient to manage on their own. ## Indications - Scheduled change of the system, generally every 4 to 7 days depending on the type. - Leaking, lifting, odour, exposed skin, itching or burning under the barrier. - Daily assessment of the stoma and the surrounding skin. - Teaching the patient and family before discharge. ## Contraindications and precautions - After surgery the stoma is swollen: measure at every change, because it shrinks. - Remove the barrier gently, supporting the skin, with adhesive remover if needed: the surrounding skin is easily injured. - An opening that is too small rubs and injures the stoma; one that is too large leaves skin exposed to output. - In an ileostomy the output is liquid: the barrier must fit well so there are no leaks. - Assess the patient's dexterity, eyesight and mood, which affect self-care. ## Equipment - A one- or two-piece system (barrier and pouch) of the right size and a clamp if used. - A measuring guide, curved scissors and a marker. - Gauze, warm water and a towel; adhesive remover and skin protectant if used. - Clean gloves, a pad and a waste bag. ## Step by step (and why) - Identify the patient, explain and invite them to take part — learning by watching prepares self-care. - Empty the pouch and look at the output — amount, colour and consistency show how the bowel is working. - Remove the barrier from top to bottom while supporting the skin — pulling it off injures the surrounding skin. - Clean the stoma and skin with warm water and pat dry — the barrier will not stick to damp skin. - Assess the stoma and the surrounding skin — colour and skin show blood supply and leaks. - Cover the stoma with gauze while you prepare the system — so output does not wet the cleaned skin. - Measure the stoma and cut the barrier 2 to 3 mm larger — it protects the skin without rubbing the stoma. - Apply the barrier centred and press for a few seconds; attach the pouch with the outlet down — the seal prevents leaks. - Close the pouch, discard waste and record stoma, skin and output — the record catches changes early. ## Complications - Ischaemia or necrosis of the stoma: pale, purple, bluish or black colour. - Skin irritation around the stoma from leaks or the adhesive. - Changes in body image and mood that make self-care harder. - Leaks from a poorly fitted barrier, with skin damage. - Urinary tract infection with a urostomy; some mucus in the urine is normal, blood is not. ## Next step: when to call for help - Report at once a stoma that is pale, purple, bluish or black, or looks dry or very swollen. - Report a foul discharge, bleeding that does not stop or damaged skin around the stoma. - Before discharge, report if the patient or carer cannot empty and change the pouch. - With a urostomy, report blood in the urine or signs of urinary infection. - Ask for the stoma nurse when possible, also for the emotional impact. ## Test yourself Think of the answer, then tap the question to see it. ## What does a healthy stoma look like? Moist and pink or red. Right after surgery it is swollen and shrinks over the following weeks. ## Which stoma signs are reported to the doctor? A pale, purple, bluish or black colour, a dry look, marked swelling or a foul discharge, because they may mean poor blood supply or infection. ## How large should the barrier opening be? About 2 to 3 mm larger than the measured stoma: it protects the skin without rubbing the stoma. ## When is the ostomy system changed outside the scheduled change? If it leaks or smells, if skin is exposed around the stoma, or if there is itching or burning under the barrier. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/ostomy-care-changing-the-pouch-and-assessing-the-stoma/) ## Connections ## Related 3 - [Bowel elimination: constipation, enemas and faecal impaction](https://durgical.com/en/nursing/bowel-elimination-constipation-enemas-and-faecal-impaction/) - [Urinary elimination: retention, incontinence and bladder scanning](https://durgical.com/en/nursing/urinary-elimination-retention-incontinence-and-bladder-scanning/) - [Patient education and teach-back](https://durgical.com/en/nursing/patient-education-and-teach-back/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Skills, 11.7: Managing Ostomies](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/11%3A_Facilitation_of_Elimination/11.07%3A_Managing_Ostomies) (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); [Nursing Skills, 11.15: Checklist for Ostomy Appliance Change](https://med.libretexts.org/Courses/University_of_South_Carolina_Upstate/Nursing_Skills_(OpenRN)/11%3A_Facilitation_of_Elimination/11.15%3A_Checklist_for_Ostomy_Appliance_Change) (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/ostomy-care-changing-the-pouch-and-assessing-the-stoma/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/ostomy-care-changing-the-pouch-and-assessing-the-stoma/