Name: ____________________________________ Date: _________________
Pouch System: Two Piece: □ Wafer: moldable accordion
□ Pouch: ____
One Piece: urostomy
□ No Sting adhesive remover □ No Sting skin protectant
□ Stomahesive powder – use only when
needed * see steps below
□ Night time drain bag
□ Urine Bag Connectors
□ Paste_________________________ □ 4x4 nonsterile gauze pack ______________
_____________________________ □ _______________________________
Change Pouch System every 3-4 days and more often if needed.
1. Prepare wafer: mold or trace and cut ( for one piece) starter hole slightly bigger than the
stoma size/shape. Stoma Size________ Date:______
2. Remove old wafer/pouch system with adhesive remover.
3. Clean skin around stoma with lukewarm water. Dry.
4. Apply skin protectant on skin around stoma. Dry. Skip or disregard this step if skin is
irritated, red, or raw. Follow instructions below for irritated, red or raw skin.
* If skin is irritated, red, or raw, apply stomahesive powder on the irritated skin only.
Dust off excess; apply no sting barrier on powdered areas. Or you may blot with
moistened fingertip. Repeat x 2. Dry. Use rest of no sting barrier to protect intact
skin around stoma.
5. Pat skin dry around stoma, remove plastic backing from wafer, apply wafer.
Remove paper backing from wafer (tape collar).Stretch and apply tape collar to skin.
Attach pouch to accordion flange or ring.
*For one piece pouch system: Center hole over stoma, apply pouch.
Immediately, gently rub finger on wafer around stoma.
6. Empty pouch when 1/3 full. May connect to bedside bag at bedtime.
7. Rinse bed side drain bag twice a week or if needed with vinegar solution: one part
vinegar and 3 parts water. Pour solution through tubing. Leave solution in bag for 20 to
30 minutes then drain. Do not rinse bag
Drink at least 10 8oz glasses of liquid per day (or as allowed).
Go to the nearest emergency room if stoma turns dark color (dusky
blue, grey, brown or black) or if bleeding from stoma.
For other concerns, questions or problems, call the Urology Clinic at 608- 263-4757 and ask to
speak to your Doctor’s Nurse.
Discharge Ostomy Supplies
Ostomy supplies are usually covered by your insurance. If you have Medicare, it will pay 80%
of the cost. If you also have a supplemental insurance plan, it will cover the other 20%. It is best
to find out first from your supplemental insurance where you can get your ostomy prescription
filled. Many private insurance plans or HMOs will pay the full cost of the supplies as long as
they have been prescribed by a doctor. Your prescription will need to be renewed every 90 days
to keep having the cost of supplies covered. After 6 months, it can be renewed by your primary
We will provide you with a small number of supplies when you go home. If you have been set
up for home health visits at discharge and you have Medicare, they will provide you with
supplies while you’re followed by Home Health. Once you have been discharged from Home
Health, call the Urology Clinic at (608) 263-4757 and leave a message for your Doctor’s nurse
with the name of your preferred provider. We will fax or e-mail your prescription to them. They
may mail the supplies to you or you may need to pick them up. Your provider may set a regular
schedule to deliver your supplies. Others may want you to call when you need more. They will
need a copy of your prescription.
If you do not have Home Health or Medicare, you will be discharged home with enough supplies
until your first clinic visit. At that time, you will receive a prescription for more ostomy
supplies. We can fax or e-mail this to your provider, or you may take it with you.
Do not order too many supplies before your first clinic visit. Most stomas shrink. You will
likely need a new prescription with your new flange size at that clinic visit.
Diet Guidelines: please refer to
If you have more questions please contact UW Health at one of the phone numbers listed below.
2880 University Avenue
Madison, WI 53705
UW Health West Clinic
451 Junction Road
Madison, WI 53717
UW Health East Clinic
5249 East Terrace Drive
Madison, WI 53718
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 7/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7433