1. Walker, Cynthia A. MSN, RN, APRN-CNS, CWON

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1. Myth: The ostomy pouch should be changed while lying in bed.

The best position is sitting or standing to promote visualization of the stoma and pouch. Once cleared to shower, patients can choose to remove a pouch while showering, pat dry, and reapply.


2. Myth: Patients graduate from a one-piece appliance to a two-piece pouching system.

Stoma and abdominal characteristics with patient preference are considered in appliance selection. A two-piece system may not be the best match for patients with poor dexterity, irregular stoma profiles, or certain abdominal characteristics. Nurses must respect the patient-centered needs and avoid nurse-centered appliance choices.


3. Myth: All ileostomy patients have diarrhea.

Ileostomy effluent is primarily liquid as it exits the small intestine. Nurses must be alert to output volume and changes. Early interventions are needed when ileostomy output exceeds 1 to 1.5 liters as dehydration followed by kidney injury may occur.


4. Myth: Excessive paste around the entire wafer will save a leaking appliance.

Once a pouch begins to leak it must be changed and the underlying reason for leakage must be addressed. Resizing the stoma, reviewing skin care, and managing irritations are the first steps in problem solving. Pouches can be cut to match the stoma opening with no greater than 1/8" overage. Skin cleansing with plain water prevents residue build up. Skin protectants are not needed. Early management of skin irritation often corrects the unintended pouch leak.


5. Myth: If the pouch isn't leaking, don't change it.

A pouch change every 3 to 5 days is recommended. Establishing a change routine works well to inspect the stoma and peristomal skin. Urostomies are best changed in the early morning before the first cup of coffee.


6. Myth: After a fecal diversion, rectal sensation or discharge indicates a post-op complication.

If the rectum remains, mucous secretion continues. Old stool, blood, and mucous discharge and/or sensations to have a bowel movement can be frightening experiences after ostomy surgery. This is normal.


7. Myth: Ostomy patients should empty pouch contents in to a clear container or the sink.

If able, ostomy patients should sit on the toilet and empty the pouch directly into the toilet. No need to use a secondary collecting container unless strict output is required.


8. Myth: Obtain a urine culture directly from a clean urostomy pouch.

Ostomy pouches are clean, not sterile. Often a specimen can be obtained directly from the stoma after cleaning the stoma similar to a clean catch technique. Straight catheterization of an ileal conduit requires specialized training (usually done by a wound, ostomy and continence (WOC) nurse).


9. Myth: Odor and leaking accidents are just part of having an ostomy.

Patients with ostomies must strive for secure and reliable pouching systems. Accidents do happen but living with pouch failure is not acceptable. Odor is expected only during pouch emptying or changing. Odor usually suggests a leak in the system. Contact your local WOC nurse to discuss leaking and odor issues.


10. Myth: The home care nurse will change your pouch and provide all your supplies.

Skilled nursing coverage is intended for teaching the patient and/or caregivers ostomy care and assessing stoma and peristomal surfaces. Nurse-managed pouch changes are not a reimbursable skilled visit. Supply coverage varies with specific insurance reimbursements. WOC nurses and industry partners can assist home care nurses in this crucial intervention prior to discharge from home care services.