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How do I know I cut the flange properly - not too small and not too big?

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Tue Mar 23, 2021 10:46 am

Hello all, 

This is my first post. I am 6 weeks post-ileostomy and I changed my bag for the first time myself today (nurses had helped previously). I measured and cut but I'm worried it is too small. I think this is just anxiety, but how do you know if the fit is too snug? My ostomy nurse said the stoma could be strangled if the fit is too tight, but since the stoma doesn't have sensations, what are the signs if it is too tight?

 

Many thanks for any help!

Dilia 

Tue Mar 23, 2021 11:41 am

On my ileostomy,I cut mine about 1/8-1/4 away from my stomach . I do use a convex appliance with a protective ring under to absorb the moisture from my high output . The ring gets places slightly away from my stoma as the stoma is always moist .

don't stress ....relax and if all else ...no , don't let the sides of your appliance touch your stoma

ritz

Tue Mar 23, 2021 1:51 pm
Ritz wrote:

On my ileostomy,I cut mine about 1/8-1/4 away from my stomach . I do use a convex appliance with a protective ring under to absorb the moisture from my high output . The ring gets places slightly away from my stoma as the stoma is always moist .

don't stress ....relax and if all else ...no , don't let the sides of your appliance touch your stoma

ritz


Typo ...not stomach ....stoma ! After cutting,those ridges can cut your stoma , so be careful. I stand to change mine without a mirror...it's easier. Coloplast makes special scissors to easily cut for about 4-. I bought 2. If you need any info , don't hesitate to post ..we're all here to learn,help and laugh 
Ritz.....keep us posted 

Tue Mar 23, 2021 2:12 pm

Hello Deedee 42.

Yes! the curved scissors are really handy. However, If you ask the manufacturers of the bags, they nearly all have stoma ring templates , that you can put over your stoma to see what size you need the hole. Then, when you know the size, you can simply place the template over the baseplate and cut the required hole, before placing the bag in position.

I hope this helps.

Best wishes

Bill

Tue Mar 23, 2021 3:01 pm

If you haven't got any measuring guides to hand use the backing plate you pull of base before sticking base to stomach to put around stoma so you can see if it's a nice fit with just a small gap around edge of stoma.

Don't worry about strangling stoma the hole would have to be extremely small to do that you would have difficulty even getting the base over your stoma and have constant leakages so you would know yourself long before that there was a problem 

Tue Mar 23, 2021 4:35 pm

Hi DeeDee,

  You need to make yourself a template that you can use over and over each time you cut your new barrier opening.  Once you have the template then every time you cut a barrier........the clear plastic part you peel off before you stick it will be a copy of that template........so you'll never have to make another, unless your stoma changes shape.  So to start just get some thin cardboard or clear rigid plastic.  Start with a small hole in the center and keep cutting it larger an larger until you get to the size you need.  You can even cut the cardboard or plastic in half and cut just half your stoma in each.  Then with both halves around your stoma in the proper position just tape the two pieces together.  Then remove and transfer your hole to either a barrier (if you're ready to apply it) or another piece of plastic for a permanent template.  If your barrier is convex then peel the clear plastic cover off it, and make the template out of that.  Easy peasy!!  

 How tight around your stoma is your choice, but the less of a gap between the barrier and the stoma the better.  I use a ring (and highly recommend them) and what I do is cut the hole really snug for my stoma to fit thru, but I also put my ring on my barrier before I apply them as one piece.......and I squeeze the inner diameter of the ring to exactly match the hole in my barrier.  Once they match perfectly I pinch them together to make sure there' a good bond between them.....and then apply.  Then just finish with whichever ritual you prefer to help the barrier stick to your skin, be it pressure or heating up the area first...and you're good to go.  

 

regards,

bob

Tue Mar 23, 2021 8:16 pm

Dee dee,

You have  gotten  some great advise here. I use a two piece pouch system so the barrier comes in a package that you peel back the top paper. I have cut the hole with that paper still attached and when I pull it off, I keep it and it is my template. The next time, I tear the top paper off and place the one that I cut the previous time onto the barrier and draw the outline of the hole with a pen onto the back of the barrier. Then I cut it with scissors and it fits perfect every time. I keep the one and use it over and over. Your stoma may change shape after it heals. Mine went from a perfect little round stone to a slightly oblong stoma. So don't be afraid to adjust for that. I keep all I need, scissors, pen, and template in the box the barriers come

in. I also write the date I change my barrier on the top of the box. Nice to keep track. Sometimes I just forget to change it and unless something happens like a leak or coming loose, I will wear a barrier on average 10 days. I have gone 18 days just to see if I could! Lol 

Glad you found this site! It is so helpful! 
puppyluv

Tue Mar 23, 2021 9:04 pm
Puppyluv56 wrote:

 I have gone 18 days just to see if I could! Lol 

18 days???  I'd forget I had an ostomy if I could go half that time between changes!  That's amazing!!!  Not to mention what a mess my skin under my barrier would look like.........YIKES!  Good for you!

regards,

bob

Tue Mar 23, 2021 9:47 pm

I use holister supplies and there is always a temples in the box of wafers for different sizes. I really just cut mine along the lines on the wafer. best wishes and stay safe

Wed Mar 24, 2021 9:07 am

Hi Deedee i use convatec pouches and there,s a template for sizing your stoma in every box of the wafers, after i had resection surgery my new stoma was considerably larger than the old one plus it was swollen from the surgery so i had to use differant size templates as my new stoma shrunk down to its current size and like others said i put the temp. on back side of new wafer and draw the circle and cut it out, its about an 1/8 in. larger than my stoma, after i peel the paper off i run my finger around the edge i just cut to blunt it so there,s no sharp edges.

Wed Mar 24, 2021 6:57 pm

thank you very much to everyone who responded. I feel a little better getting all this advice. I was nervous yesterday that I did it too tight so I changed it today again to a little looser with the 1/8inch larger than my stoma. I'll see how that works. There seems to be a tiny space of skin showing so hopefully that's okay and noothing will leak there. Live and learn I guess. If it does leak, I'm sure everyone with an ostomy has had that issue at one point. many thanks again!

Wed Mar 24, 2021 8:08 pm

Hi Deedee! I'm not so ambitious about managing my ostomy as most of these folks here. I use a precut convex ring (Convatec two piece) and under that I use an Eakin seal that you can stretch to the size you require. I make it just slightly larger than my stoma. If you are changing standing up as I do, you can hold a mirror in one hand and the seal or gasket in the other you can easily see where to place them. Just be patient and breathe. Take care!

Nurse
Wed Apr 28, 2021 2:37 pm

When you cut the hole in the barrier, set it over the stoma before removing the clear protective layer, just in order to check the fit.  You should see a 1/16" gap between your stoma and the barrier all the way around the stoma.  That is enough.   

Bob's idea to create a template is good for mature stomas.  When your stoma is new, it will typically change size (getting smaller over the first few weeks to months).  For this reason it should be measured at each pouch change until you note over several pouch changes that the size is no longer changing.  At that point you can use a template and precut several barriers at a time, or order precut for most systems.


_________________
RN, CWCN, COCN
Wed Apr 28, 2021 4:56 pm
w30bob wrote:

18 days???  I'd forget I had an ostomy if I could go half that time between changes!  That's amazing!!!  Not to mention what a mess my skin under my barrier would look like.........YIKES!  Good for you!

regards,

bob


I can only go 2-3 days without changing 

Wed Apr 28, 2021 6:16 pm
w30bob wrote:

18 days???  I'd forget I had an ostomy if I could go half that time between changes!  That's amazing!!!  Not to mention what a mess my skin under my barrier would look like.........YIKES!  Good for you!

regards,

bob


It is easy to forget.I prefer to do the 10 day thing but because I do forget to change it, I have to check my dates and it is usually 11 or 12 days! lol

Pup

Wed Apr 28, 2021 8:04 pm

 Can you go that long because you use irrgation? Best wishes and stay safe.

Wed Apr 28, 2021 8:40 pm
lovely wrote:

 Can you go that long because you use irrgation? Best wishes and stay safe.

I have gone that long with a drainable pouch and not irrigating.the Convetec two  piece I use just seems to work well for me. No skin problems. The Coloplast worked that well for me too but I don't like that click system they use for the porches to latch onto the flange. I sure like their pouches better, other than the click. Irrigation is probably why I can get 18 days out of a barrier. I still have output. And water from irrigation gets under the flange around the stoma. Even though irrigation has made my life so much easier, I am not one of the lucky one that have no output in between irrigation's. It is my own fault because I will always eat what I want and pay the price verses depriving myself for the sake of not having to poo! Lol

Pup

Wed Apr 28, 2021 9:29 pm

I forgot to mention that if you prefer to cut your own ring size, you can also get a cutter with whatever ring size you need. I have a cutter that is 1-1/8" for times when I can't get a precut ring. They make all sizes and they last a very long time.

Thu Apr 29, 2021 9:49 am
Ritz wrote:


Typo ...not stomach ....stoma ! After cutting,those ridges can cut your stoma , so be careful. I stand to change mine without a mirror...it's easier. Coloplast makes special scissors to easily cut for about 4-. I bought 2. If you need any info , don't hesitate to post ..we're all here to learn,help and laugh 
Ritz.....keep us posted 


Oops ...STOMA !

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