A closed ostomy system is a type of pouch for ostomy patients, which includes a single-use only closed ostomy bag sealed at the bottom.
When should a person use a Closed-Ostomy System?
People require a closed ostomy system after ostomy surgery. “An ostomy can be deﬁned as any surgical procedure resulting in the external diversion of feces and urine through a stoma. The most common ostomies are a colostomy and ileostomy for diversion of the fecal stream, and urostomy for diversion of the urinary stream. Persons living with ostomies require specialized care and management to sustain physical health and quality of life (QOL). The provision of specialized ostomy care begins preoperatively and continues throughout the postoperative and rehabilitative period and throughout the patient’s lifetime with an ostomy. Ongoing stoma and ostomy appliance sizing, the treatment of peristomal skin complications, ostomy appliance modiﬁcations, access to ostomy products and financial assistance, dietary consultation, and emotional support are just a few of the health management issues that require ongoing management following creation of an ostomy.”1
Closed ostomy pouches are ideal for those with predictable or infrequent discharge, such as colosomates. Urostomates and ileostomates might not benefit from this system as they have recurrent leaks. As a disposable system, do not clean or reuse it. Follow the manufacturer’s instructions to discard the pouch.
The Basics of Closed Ostomy Systems
“Pouches come in a variety of styles and sizes that do not show under clothing. They are made of disposable materials and designed to be worn once and then discarded. Many colostomates wear a pouch. For example, those who have a transverse colostomy, those who do not wish to irrigate and those who have some output between irrigations. Basically, they all do the same job. They collect stool that may expel expectantly or unexpectedly. Some are open at the bottom for easy emptying. Others are closed and are removed when filled. Others allow the adhesive faceplate or flange to remain on the body while the pouch may be detached, emptied or replaced. Pouch flanges are available in both convex and flat surfaces. Everyone, including those who irrigate, needs some type of stoma pouch on hand, if only for emergency purposes.”3
Considerations When Choosing a Closed Ostomy System
- Patient’s comfort
- Ability to apply the pouch
- Frequency of pouch emptying
- Consistency of the discharge
- Location of the stoma
- Wearing time
- Patient height
- Abdominal contours
- State of the peristomal skin
- Stoma shape
- Cost of the ostomy supplies
“Choosing one ostomy appliance over another for the individual with a stoma can be problematic. There are numerous appliances to choose from and manufacturers often claim that their products are the best on the market without providing objective, clinical evidence of the actual performance of the products. Consequently, most choices of appliances are based on habit or the clinical experience of nurses. During the 1990s, an increasing need for evidence-based decisions within ostomy care led to numerous calls for more ostomy research. Both health authorities and ostomy product manufacturers should support the need for stoma care professionals for clinical research to enable evidence-based decisions to be made.”5
Advantages of Closed Ostomy Pouch Systems
- Fast changing.
- Some brands offer flushable options that are readily available and can, therefore, be environmentally friendly.
- Increases patient confidence as chances of accidental leakage diminishes. Complicated drainable systems increase the risk of something going wrong before it is time to drain the bag.
Closed Ostomy Pouch Systems are ideal for
- Patients who perform stoma irrigation
- Ideal for patients who find cleaning and reusing too cumbersome.
- Patients with well-formed stools
- Changing in public restrooms or at someone else’s house.
Disadvantages of Closed Ostomy Pouch Systems
- Not ideal for liquid discharge, as in urostomy patients.
- Stressful when traveling or when in social settings. Appropriate disposal facilities may not be available in certain places.
- One-piece pouch systems might increase the risk of skin irritation and inflammation due to constant pouch changing.
- Each manufacturer may have different pouch sizes and shapes, causing confusion in patients.
“Ostomy bag users regularly experience problems, such as peristomal skin disorders, leakage of stoma effluent onto the peristomal skin, excess air in the bag (ballooning) and odor. The quality of life of the individual with a stoma appears to be related to his or her anxiety about the bag adhesive loosening or leaking, odors emanating from the bag and skin complications in the peristomal area. Although the one-piece closed ostomy bags already established on the European and US markets are of a high standard, improvements in the performance of the bags, primarily in relation to the adhesives and the filters, are still needed.”6
Precautions with a Closed Ostomy Pouch System
- Gas can cause pouch distention. An incorporated charcoal filter can prevent this situation.
- Switch to a drainable bag type if the discharge changes to a looser consistency. Discuss the discharge consistency changes with a physician, whether it is due to a nutritional cause or a disease process.
- Change the pouch when 2/3 to 1/2 full.
“Ostomy care comprises a broad spectrum of preoperative and postoperative tasks covering the management of the various types of ostomy. For enterostomies, the principal preoperative task is the provision of professional advice and training to the potential ostomy bearer and family members. Together with direct stoma care, the psychosocial and nutritional aspects must be discussed.”7
Whether they are one or two-piece, closed ostomy systems have various advantages and disadvantages, depending on the ostomy type. The closed-end pouch is sealed and requires disposal after each pouch change. Unlike the closed system, the drainable type allows users to discharge the content, rinse the pouch and reuse it.
Users with less discharge and more consistent stool prefer closed ostomy systems, as they have a special filter that reduces odor and gas accumulation (absorbing odors while allowing gas to escape). These could also include pre-cut or cut-to-fit flanges.
Patients might feel overwhelmed seeking the right pouch, as they can choose from a variety of brands and styles. Speaking to an ostomy nurse before leaving the hospital will help decide between the different options available.
(1) Ostomy Care and Management A Systematic Review. Recalla, S., English, K., Nazarali, R., Mayo, S., Miller, D. & Gray, M. Journal of Wound Ostomy Continence Nurse. 2013. https://www.researchgate.net/publication/251568692_Ostomy_Care_and_Management_A_Systematic_Review
(2, 3, 5) Colostomy Guide. Hooper, J. & Gutman, N. United Ostomy Associations of America. 2017. https://www.ostomy.org/wp-content/uploads/2018/03/ColostomyGuide.pdf
(4, 6) Ostomy bag management: comparative study of a new one-piece closed bag. Voergaard, L.L., Vendelbo, G., Carlsen, B., Jacobsen, L., Nissen, B., Mortensen, J., Hansen, G., Bach, K. & Bæch, S.B. British Journal of Nursing. 2007. https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2007.16.2.22767
(7) Intestinal Ostomy: Classification, Indications, Ostomy Care and Complication Management. Ambe, P.C., Kurz, N.R., Nitschke, C., Odeh, S.F., Möslein, G. & Zirngibl, H. Deutsches Ärzteblatt. 2018. https://www.aerzteblatt.de/int/archive/article?id=196925