This article is also under the colitis blog, but I thought caregivers would find it very useful as well, so I included it here also.

Anybody can change an ostomy bag.  But, to make as little skin irritation as possible and to make the wafer stick for several days takes practice.  Here are some of the tips and tricks I found helpful.  Some of them were taught to me by ostomy nurses, some of them I learned by practice.

I prefer the 2-piece system, one in which the wafer and bag are separate pieces.  The reason is that you can turn the wafer the exact angle that you want it and have the bag connected to hang at the angle you want.  I used the flat wafers, but others may require tapers, depending on the contour of their belly.  I usually preferred the wafers that I could cut to size.  They seemed to keep their shape and stick a little better than the mold-able wafers.  As far as the bags I really liked the ones with a cloth mesh backing.  They didn't seem to stick to the skin as much.  Although, with time you get used to having the plastic bag on your skin.  I also liked the built in gas-permeable filter vent (Hollister sells one).  The advantage of the vent was not having to burp the bag as often to release gas buildup.  It is important to remember to cover the vent with the sticker it comes with whenever you bath or shower.  If you don't cover it and it gets wet from the outside, not only will it not vent gas very well, but it will also start to leak liquid out the filter.  So put the sticker on, when you shower, take it off when you're done.  Enough about my wafer and bag preferences   Let's talk about changing the wafer and bag.

Get several warm, wet washcloths ready and a small dry towel as well.  You will need these later.  I recommend sitting on the toilet when you change the bag.  That way the mess can fall into the toilet.  You may find that certain times of the day you have little or no drainage (based on when you last ate).  It's a good idea to time changes for those times.  First remove the old bag.  You can just pull it off, but after doing this a couple times your skin will get very irritated and will probably get sores as well.  Use adhesive remover.  I really preferred the alcohol-free adhesive remover as it did not burn.  Some of these even have a nice citrus scent to them.  Once the bag and wafer are removed gently wipe the area with a wet washcloth to remove any pieces of the wafer or adhesives that remain behind.  If you have used stoma paste it will likely be quite messy.  If you plan on using paste again, it is alright to leave some paste on the skin.  So get off what comes easily.  Scrubbing too long will just irritate your skin.  If you do NOT plan on using paste, then leaving paste behind will make the area less flat and harder to stick too.  You will need to remove all the past in this case.  Be patient, the warm wet washcloths will do the trick.

Next get your wafer ready.  (You may eventually do this prior to removing the old one, once you get good at eyeballing the size.)  If you choose the wafer that needs cut, first cut it to size.  Be careful to make smooth cuts and be sure to leave just enough gap that the wafer will not actually touch the ostomy.  If it touches the ostomy, especially with rough cuts, it will irritate the ostomy and make it bleed.  If you use a moldable wafer, then mold it to the right size by rolling the extra material over the top of the wafer.  If you roll it underneath it will not adhere properly.  Once you've got the wafer cut, get it warm.  It will stick much better when it is warm.  So stick it under your thigh or armpit while you get the site ready.

To get the skin ready you need to remove any hair.  You may get away with this step every-other change.  You may get away with this step even more frequently if you are a female or don't have much hair on your belly.  Do NOT use alcohol based shaving cream.  It will burn the skin.  The best way I know of is to sprinkle baby powder on the area (not on the stoma itself) and use a disposable style razor to shave.  The baby powder will act as lubricant and will not burn the skin.  If you do not shave off the hair, it will hurt next time you remove the wafer.  It may also cause sores from pulling the hair.  Once you are done shaving, clean the area with one of the warm wet washcloths.  Then pat it dry with the towel.  You are almost ready to apply the wafer and bag.

Use a skin prep to get the skin ready.  The skin prep protects the skin from moisture and also makes the adhesive stick better.  This leads to less skin irritation.  Once you are done with that carefully sprinkle stoma powder around the stoma on any sore areas.  Do NOT sprinkle it directly on the stoma.  Your stoma needs to be moist and pink, not dried out by the stoma powder.  Gently rub it in the areas that need it with your finger or a cotton swab.  If you sprinkle too much of this on, the wafer will not stick well, so only use it where needed.

Now to apply the wafer and bag.  It is easier to connect the bag before the wafer is pasted on your skin.  Connect the bag, being sure to turn it the way you would like it.  Next peel off the backing from the wafer.  Hopefully you have been warming the wafer up so it sticks well. Next, spray some adhesive on the wafer.  Hollister sells this in a small can.  It doesn't take much of this, just enough to get some on the entire wafer.  Let the adhesive dry a little so that it is tacky to the touch.  If you do not let it dry enough (or too much) it won't stick very well.  Once it's tacky stick it on your skin.  If your stoma leaks while you are waiting for the adhesive to get tacky, clean and dry the area and apply some more skin prep.  Then add spray to the wafer and let it get tacky.  One trick I found when applying the wafer to my skin was to sit up really straight to stretch out the skin on my belly a little.  I found if I didn't do this, the wafer may pull off the first time I stretched.

Your directions may require additional steps to place barrier rings prior to putting on the wafer.  The purpose of those is to make your skin more flat so that the flat wafer will stick properly without a gap underneath it.

How do you know when to change the bag again?  With practice you will find what works for you.  The wafer will generally stick well for 3-5 days.  If you are at the end of the time that usually works for you, change the bag.  You don't want to find it coming loose at an inconvenient time.  I could always tell my wafer was starting to get a little leak under it because it itched.  To protect your skin, always change it if it starts leaking and use skin prep.  In an emergency (like if I was out in public and knew it was getting leaky) I would stick some stoma paste under the wafer where needed.  I only used that as a temporary fix, because it was so sticky and hard to get off of the skin.  It's a really good idea to always take a small bag of supplies and a plastic bag for your trash with you.  You never know when you may need it.

Got any other tips you care to share?  Please leave your comments below.  Thank-you.

If you or a loved one goes in to the hospital emergently, you may not have time to grab much to take.  However, if you go in for a scheduled procedure, you should have time to  pack a bag.  Likewise if your loved one is in the hospital this list may give you an idea of things they might like to have with them.

Things to Take to the Hospital

Living Will - this document spells out your wishes regarding CPR, intubation, life support and the like.  If you know what you want, put it in writing.
Prescription List - if you can't take it, bring your prescriptions.  If you have a list, please leave your medications at home.  You don't want to take something the nurse already gave you.
Insurance card - this one is kind of obvious.
Pacemaker Card  - if you have a pacemaker, the hospital needs to know some details about it.  This lets them know what type of pacemaker you have and if it's MRI safe.
Walker or Cane - if you need a device to get around, please bring it.
Change of clothes - at least a change of underwear for the day you go home will feel nice.
Cell Phone Charger - no, we don't have a charger for your cell phone.
Phone List - we will likely have a hard time looking up somebody's number for you.  Most people have cell phones that we can't just look up on line.
Razor - yes, we have razors, but they don't feel as nice as the one you have at home.
Toothbrush - yes, we have toothbrushes too, but they are the cheap kind.
Hairbrush - we probably only have combs, and those aren't very fancy.
Deodorant - many places don't carry this, and if they do, they probably don't carry your brand.
Feminine Hygiene Products - if you need these, you won't like the hospital quality, or lack of selection.  It may also be a good idea to bring underwear to go with the products.
Books or Magazines - unless you want to watch television all day, we don't have many activities for you to do.
A Good Attitude - the hospital staff works hard for you, a good attitude lets them know you appreciate it.

Things to Leave at Home

Prescriptions - just bring the list.
Jewelry - please don't wear jewelry, you may have to remove it at some point.
Valuables - many places have a safe, but it takes time to get your things out when you are ready to leave.

One night while working as an Air Force Medic, I had the privilege of meeting a former Tuskegee Airman.  The Tuskegee Airmen were a group of African-American fighter pilots during World War II.  They were segregated from others in the military due to the color of their skin.  This patient was of course, African-American as well.

Early in the shift it was discovered that this man needed a new IV.  Another medic I worked with mentioned that to me, so I went to his room to start the IV.  I had scarcely placed the tourniquet on his arm when a Registered Nurse (an officer) and a Medical Technician (an enlisted person who outranked me) from the SCU (Special Care Unit) entered the room.  They asked what I was doing and I informed them that I was starting an IV.  Apparently the other medic on the Medical Surgical Unit I had talked to, thought she couldn't get the IV, and had called the SCU to try.  They asked why we had called them.  I informed them that "I" hadn't called them.  They made several other rude comments, insinuating that my IV skills couldn't possibly match theirs and that I shouldn't bother calling them back and wasting their time.  Then they left.

How unprofessional for coworkers to have a disagreement and for them to treat me that way in front of this patient.  After they left the patient asked me my name.  He then informed me, "Holverson, you are going to start this IV.  I don't care how many times you have to stick me.  Those women had no right to treat you like that."  I started the IV.  I don't remember how many sticks it took for sure.  I do remember that each time this man was admitted to the hospital after this he specifically asked if I was available to start his IV, so it probably only took one stick.

I always enjoyed listening to retiree stories about their military careers and casually asked this man what he did in the military.  When he informed me that he was a retired Tuskegee Airman, I initially didn't believe him.  He looked way too young.  I of course checked his age in his medical record.  He was indeed old enough to have served during World War II.  When I found time, I returned to his room to hear more about his experience.  He proudly shared stories with me.  He talked about how unfairly they were treated by being segregated.  He told me how they hadn't been allowed to actually go to war.  He told me how President Roosevelt's wife came to visit.  He said she demanded a ride in a plane with one of the Tuskegee Airmen.  She asked their commanders why they hadn't been allowed to go to war, given they had been properly trained.  He told me that Mrs. Roosevelt was instrumental in getting them into the war, allowing them to demonstrate their abilities.

He told me about more challenges he had after the war.  In the military most pilots are officers or warrant officers.  The black fighter pilots weren't given that opportunity following the war.  He was made an enlisted man, even though he had demonstrated the same skills as his superior officers.  He had endured mistreatment and I came to understand that was the reason he stood up for me.  For that man, principle was very important, more important than how many needle sticks it took to start his IV.