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The Ostomy Files: Decision for Selection: A Logical Approach to Pouching System Selection
Among the most difficult challenges facing clinicians are selecting an appropriate pouching system for an ostomy patient and resolving a patient’s existing management problem. Modifications in pouching technique or product usage can alleviate peristomal skin problems, stop leakage, and dramatically improve the quality of a patient’s life. Because so many different brands of ostomy products are available, as well as multiple options within each brand, deciding on the right product can be daunting.
The first step is to become as familiar with ostomy products as possible. This can be accomplished by reading ostomy-related journals and textbooks, attending seminars, and meeting with ostomy manufacturer’s representatives — a great source of information. Once you are comfortable with product knowledge, the next step is to develop a methodical approach to pouching system selection (see Figure 1). Thinking about the three letters, D, F, and S, (Decision For System) will help you remember you have three decisions to make at each of two Decision Points. This simplistic approach to product selection assumes that the clinician has a working knowledge of ostomy products and that a comprehensive patient and abdominal assessment already has been conducted.1
Basically, ostomy products have two components — a skin barrier and a pouch — regardless of brand. Each of these components is available in a variety of shapes, configurations, and formulations.
Because the skin barrier is the most important portion of the pouching system,2 it should be the first decision point. Three other decisions regarding the skin barrier include the dimension, formulation, and the type of stomal aperature (DFS). Skin barriers are available in two formulations (standard and extended-wear), and two dimensions (flat and convex). They are also available with precut, cut-to-fit, or moldable stomal aperatures.
The next decision point is the pouch. This decision should be influenced by the patient’s preference,1-3 functional limitations, nature and quantity of stomal output, and lifestyle. Again, there are three options at this decision point: the design of the pouching system, the pouch fabric, and pouch style (DFS). Pouching systems are designed as one-piece systems (the skin barrier and pouch are manufactured as one unit) or two-piece systems (the skin barrier and pouch are separate pieces that are attached by a variety of mechanisms, depending on manufacturer). Pouches are available as urinary, closed-end, and drainable in either an opaque or transparent pouch fabric. Pouch styles are designed to offer alternative management methods that are aesthetically pleasing, meet patient lifestyle needs, and manage urine, stool, gas, and odor. The three styles of pouches are urinary, closed-end, and drainable.
The very simplistic DFS approach does not consider each and every ostomy accessory and product available. However, combined with a thorough patient assessment, it should provide adequate guidance on appropriate pouch selection for uncomplicated stomas. The patient’s ability to participate in and learn self-care also influences pouching system selection. For example, recommending a two-piece cut-to-fit pouching system for an elderly patient with visual problems and arthritis of the hands might present obstacles to her remaining independent in ostomy care due to her inability to manipulate scissors or attach a pouch to a flange on skin barrier. Each patient and each scenario differs — that is why ostomy care is considered as much art as science.
It is each clinician’s responsibility to keep abreast of innovations in ostomy pouching products and technology because something as simple as modifying or updating a pouching system can be the difference between night and day in the quality of life of the person wearing it.
1. Turnbull GB. The ostomy assessment inventory: a data-gathering process to enhance appropriate pouching system selection. Ostomy Wound Manage. 1998;44(2):28–37.
2. Colwell JC. Principles of stoma management. In: Colwell JC, Goldberg MT, Carmel JE eds. Fecal & Urinary Diversions: Management Principles. St. Louis, Mo.; Mosby. 2004:240–262.
3. Turnbull GB, Colwell JC, Erwin-Toth P. Quality of life: Pre, post, and beyond ostomy surgery. Ostomy Wound Manage. 2004;50(7A Suppl):2–12.
