Enlarging the Opening of the Ostomy Pouching System: Why & How

Clinical Rationale:   Ostomy literature and product instructions vary on recommendations for the size of the skin barrier opening in an ostomy pouch, but none of these references or instructions recommend openings larger than 1/8 inch, “unless recommended by a WOC Nurse or healthcare professional”.    The authors have identified circumstances when a WOC Nurse might recommend a larger pouch opening, including dependence in stoma care, irregular stoma shape, irregular abdominal contour, and discomfort from a pouching system. 

Objectives:  1. WHY:  Identify circumstances when a larger pouch opening might be considered.

2.   HOW:  Describe important considerations when using a larger pouch opening.     

Methodology Result:   Case studies are used to describe situations when enlarged pouch openings were more successful.  Methods for enlarging the pouch opening, including skin protection, pouch considerations, and size of the opening, are illustrated.                         

Discussion:  While initial ostomy care should include solid skin barrier openings no more than 1/8 inch beyond the stoma edge, these case studies describe circumstances when alternative products were used to protect peristomal skin, and skin barrier openings were larger than 1/8 inch, yet wear time, product usage, comfort, independence improved.