Considerations: when to offer a closed end pouch for ostomy patients

About the Author

Mackenzie Bauhs, CWOCN, is currently an employee and Ostomy Clinical Consultant for Coloplast. She obtained her bachelor’s degree at Carroll University in Wisconsin. She has worked with ostomy patients in the post-operative period at the University of Wisconsin Hospital and Clinics in Madison, Wisconsin as well as outpatient ostomy care at Rush University Medical Center in Chicago, Illinois.

Mackenzie has received compensation from Coloplast to provide this information.

 

As a WOC nurse, there are many elements to an assessment of a patient. While assessing a patient with an ileostomy or colostomy, a skin, nutrition and post-operative assessment may take place, as well as an overall quality of life assessment. There are customizable options to enhance our ostomates’ quality of life with pouching solutions. Let’s explore ways to customize by teaching about closed end pouches to build patient confidence and quality of life.

When providing ostomy pouch selection options for patients with stomas, many factors come into play. Factors to consider could be ostomy type, personal preference, and lifestyle. Additionally, the patient may want to choose a different pouch system than what is initially used in the hospital.

Ostomy type and Location

Selection of closed-ended pouches for colostomy patients can be determinant on their ostomy location. Descending or sigmoid colostomies are ideal given bowel habits as well as formed stools. This specific patient population can utilize closed-end pouches in a one-piece or two-piece option.

  • The one-piece system can be changed daily or every other day, depending on bowel habits. This means the gentle adhesive is being removed from the skin more frequently.
  • The patient may instead opt for a two-piece option, leaving the barrier on longer, but removing and replacing the pouch more frequently, as needed. This helps reduce the frequency of removing the adhesive barrier from the skin.

Personal Preference

In an outpatient setting or home care setting, patients or clinicians may choose an adhesive coupling two-piece closed-end pouch. The closed-end pouch allows for a low profile, easy application of the adhesive coupling, and supports an active lifestyle. This option may be recommended for patients with poor dexterity or have difficulty with:

  • application of a two-piece mechanical coupling
  • rolling up a closure option
  • emptying adequately on their own

Caregivers may not always be available in cases where they help empty the pouch for the ostomate. Closed-end pouches also offer independence to those who are unable to adequately empty their pouch. In my experience, a closed-end pouch has been well-received by both patient and family members.

Lifestyle

Activity level is another consideration when selecting a closed-end pouch. For athletic or active patients, this is a nice alternative and can be for ileostomates or colostomates who participate in short-term activities such as swimming or yoga class. This can be a personal option that is free of worry and fit for the individual while considering the output and frequency of output or bowel habits. While assessing the patient, hobbies and activities the patient likes or is involved in can help tailor your care and pouching management as a clinician to impact the patient’s quality of life.

Intimacy is not always thought of when it comes to ostomy lifestyle and management. Closed-end pouches may be selected for convenience, confidence, or discretion if the ostomate wants to conceal their stoma and output. This allows for the ostomate and partner to have intimate moments with a shorter length to the pouch as well. Patients have shared their experience with me that he or she has used a two-piece option and selected the closed-end pouch for intimacy and then discarded and replaced with their routine daily pouch afterwards.

quote from Ostomy Life Study 2018-19

Closed-end one- or two-piece adhesive coupling or mechanical coupling pouching systems are determined by the needs, desired effects, and individual preferences of the patients. We explored a few of these options, but there are many more options available based on individual desires or lifestyles. Learning about an ostomate’s lifestyle is a unique way to personalize ostomy care. Personalizing care helps them be more confident and active, and ultimately enhances the quality of life for those living with an ostomy. ●

The materials and resources presented are intended to be an educational resource and presented for general information purposes only. They are not intended to constitute medical or business advice or in any way replace the independent medical judgment of a trained and licensed physician with respect to any patient needs or circumstances. The information presented or discussed may not be representative of all patient outcomes. Each person’s situation is unique and risks, outcomes, experience, and results may vary. Please see complete product instructions for use, including all product indications, contraindications, precautions, warnings, and adverse events.