Elimination
Considerations:
● Be sure to take steps to ensure student privacy when performing procedure.
● Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills.
● There may be a small amount of urine leakage through the artificial opening.
● The school nurse should be aware of the student’s baseline urine characteristics to identify any concerning changes that may need intervention.
Supplies:
● Gloves
● Catheter storage bag
● Disposable wipes or soap and water
● Urinal or receptacle for urine if procedure is not performed on the toilet
● Water based lubricant
● New urostomy pouch, if needed
● Washcloth
● Towel or disposable pad to place under student if procedure is done on a cot/bed
● Student’s Individualized Health Care Plan (IHCP) and health care provider’s order
● Parent/Guardian authorization form
Procedure for Pouching System Removal and Application:
1. Review IHCP and/or health care provider’s order
2. Gather equipment and place on clean surface
3. Explain the procedure to the student at their level of understanding
4. Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills
5. If the student is completing the procedure or assisting in procedure, have student wash hands
6. Carefully remove the skin barrier, being cautious not to tear the skin
a. To assist in removal, gently push the skin away from the barrier, away from the direction of hair growth
b. Loosen and lift the edge with one hand and press down on the skin near the sticky backing with the other hand
7. Place old skin barrier in garbage receptacle
8. Clean around the stoma with warm water and a washcloth or prescribed cleansing material
a. Avoid using baby wipes, oils and lotions, as they will prevent adherence of the new appliance
9. Spots of blood on student’s cleansing cloth is no cause for alarm. The blood vessels in the surface skin tissue around the stoma are very delicate and are easily disturbed. For this reason, cleaning around the stoma as you change the student’s pouch or skin barrier may cause slight bleeding. The bleeding will usually stop as quickly as it started.
a. While a small amount of bleeding with stoma manipulation is normal, continuous bleeding or bleeding from the stoma opening is abnormal and must be reported to parent/guardian and health care provider
10. Dry the skin thoroughly
11. Keep gauze or a towel handy to manage any urine output
12. Measure the stoma
13. Trace the same size opening on the back of the new appliance
14. Cut opening in pouch
a. Cut or mold the barrier as necessary, making the opening just large enough to fit around the stoma
i. Cut the opening no more than ⅛ inch larger than the stoma
b. Do not leave exposed skin around the stoma
c. Prior to placing on the skin, it may help to “warm” the wafer (also known as a flange or baseplate) between your hands to make it easier to conform to the contours of the skin
d. Most barriers adhere better when warm
15. Remove protective backing from adhesive backing or wafer surface
a. Date and keep the paper from the backing to use as your next template
16. Place the skin barrier (if using a two-piece system) or place the one-piece system over student’s stoma
17. Press your fingers firmly across the entire barrier to adhere it to student’s skin
a. Remember to make sure the skin is dry to ensure adherence to the skin
18. Keep your hand on student’s pouching system for several minutes to ensure it adheres to their abdomen
19. Dispose of used bag in appropriate receptacle per school policy
a. If pouch has a closure clip, do not discard, it can be reused
20. Remove gloves
21. Wash hands
22. If student assisted in care, have student wash hands
23. Document assessment, intervention, and outcomes in student’s health care record
24. Report any problems or concerns to parents/guardian and health care provider
References:
Lynn, P. (2019). Emptying and changing an ostomy appliance. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 297-298).
Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 36.2 pouching a urostomy. In Clinical nursing skills and techniques. (10th ed.). (pp. 1055-1058). St. Louis, MO: Elsevier.
Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 36.3 catheterizing a urinary diversion. In Clinical nursing skills and techniques. (10th ed.). (pp. 1058-1061). St. Louis, MO: Elsevier.
Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Promoting complete bladder emptying. In Clinical nursing skills and techniques. (10th ed.). (pp. 1245-1246). St. Louis, MO: Elsevier.
United Ostomy Associations of America, Inc. (UOAA). (2023). Living with a urostomy. Retrieved June 21, 2023, from
https://www.ostomy.org/wp-content/uploads/2023/06/UOAA_Living_with_a_Urostomy_Guide_2023-01b.pdf
Wound, Ostomy, and Continence Nurses Society®. (n.d.). Pediatric ostomy care. Best practice for clinicians. Retrieved June 22, 2023, from https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/PEDIATRIC_OSTOMY_CARE-_BEST_.pdf
Wound, Ostomy, and Continence Nurses Society®. (2015). Care and management of patients with urinary catheters: A clinical resource guide. Retrieved June 20, 2023, from https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/Care_&_Mgmt_Pts_w_Urinary_Ca.pdf
Wound, Ostomy, and Continence Nurses Society®. (2018). Catheterization of an ileal or colon conduit stoma. Best practice for clinicians. Retrieved June 20, 2023, from https://cdn.ymaws.com/member.wocn.org/resource/resmgr/document_library/Catheterization_of_Urinary_S.pdf
Wound, Ostomy, and Continence Nurses Society®. (2018). Urostomy urine sample collection instruction card. Retrieved June 20, 2023, from https://www.ostomy.org/wp-content/uploads/2021/04/Urostomy-Sample-Instruction-Card-for-Patients-2018.pdf
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Acknowledgment of Reviewers:
Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services
Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services
Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog
Debra Funk, BSN, RN
Director of Practice
Missouri State Board of Nursing
Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing
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Page last reviewed: June 28, 2021
Page last updated: June 28, 2021; February 14, 2024/no video
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The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.
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