One-piece ostomy bags are one of two options available after a colon or bladder diversion surgery; the other alternative is a two-piece bag.
“One-Piece Systems consist of a skin barrier/wafer and pouch joined together as a single unit. Provide greater simplicity than two-piece systems but require changing the entire unit, including skin barrier, when the pouch is changed.”1
The hospital or healthcare service frequently has a nurse specialized in wound and stoma care to teach patients about the types of collection pouches available. These can either be closed or drainable bags.
“The two main types of appliance are ‘closed’ and ‘drainable’. The former are discarded when full, the latter can be emptied and retained. An appliance can be one-piece or two-piece. The one piece consists of a bag and an attached adhesive square which sticks to the skin around the stoma. The two-piece consists of a flange that adheres to the skin and a bag that can be removed from the face of the flange without disturbing the skin.
The closed bag is usually used for a patient with a reasonably well-formed stool, while the drainable bag is used for a patient in whom frequent drainage of a loose or fluid stool is necessary (e.g., ileostomy, cecostomy or transverse colostomy). The urobags have a different kind of seal at the bottom to reduce the risk of leakage.”2
Each type has advantages and disadvantages. Each patient’s requirements and the nature of the discharge determines the use of these devices.
Use of a Drainable One-Piece Appliance
“Many drainable bags now have filters but patients report varying levels of satisfaction with the way these control odor and release of flatus. Some people prefer to release flatus via the bag outlet. Care needs to be taken so fecal spillage is avoided as flatus is being released, and patients normally require some privacy when using this method. Although flatus can be released and speedily, removal of the more solid feces through the bag outlet can be difficult. Thus patients may have to accept decreased ease of fecal removal in order to gain increased ease of flatus removal. Drainable appliances are more costly than closed ones. If patients change drainable bags with the same frequency that they would do with closed bags (in order to dispose of fecal content) this can have considerable cost implications over time.”3
More About One-Piece Bags
“Ostomy appliances (also known as stoma bags or ostomy bags) are available in many sizes and styles depending on the desired use and patient preference. These appliances have an opening near the top where the ostomy effluent drains into the bag and may have a reclosable opening at the bottom of the bag to allow for emptying. The bags may be one piece in which the adhesive seal that goes around the stoma is built into the bag or two pieces in which the adhesive seal is separate and the bag attaches to it.”4
“The word ostomy is a term for a surgically formed opening from the inside of an organ to the outside. The intestinal mucosa is brought out to the abdominal wall and a stoma, the part of the ostomy that is attached to the skin, is formed by suturing the mucosa to the skin. A colostomy permits formed feces in the colon to exit through the stoma. Colostomies are further classified by the part of the colon from which they originate. Ostomy appliances or pouches are applied to the opening to collect stool. They should be emptied promptly, usually when they are one-third to one-half full. If they are allowed to fill up, they may leak or become detached from the skin.
Ostomy appliances are available in a one-piece (barrier backing already attached to the pouch) or two-piece (separate pouch that fastens to the barrier backing) system; they are usually changed every 3 to 7 days, although they could be changed more often. Proper application minimizes the risk for skin breakdown around the stoma. This skill addresses changing a one-piece appliance. A one piece-appliance consists of a pouch with an integral adhesive section that adheres to the patient’s skin. The adhesive flange is generally made from hydrocolloid.”5
The difference between one-piece and the two-piece type is that the pouch and the adhesive that surrounds the stoma are joint. When the patient or caregiver removes the bag, the whole system is detached, exposing the stoma.
Advantages of the One-Piece Ostomy Bag
“The advantages of one-piece system include their application in fewer steps and flat positioning against the skin. Patients with arthritis, who may have minimal hand strength and dexterity and limited eyesight, may find one-piece pouches easier to apply. A one-piece system adheres easier where the skin is uneven around the stoma and the pouch is less visible under clothing. ”6
Advantages of a One-Piece system are:
- It is less evident under clothes. This is important for patients who prefer tight-fitting clothes.
- It offers greater confidence, as the pouch-flange has less chances of detachment.
- One-piece ostomy bags adhere on scarred or flabby skin.
- It is more economical since the parts come together, which can benefit permanent ostomates.
- One-piece systems have fewer parts so patients with dexterity problems as it facilitates its emptying and change.
- It facilitates user training on how to place, remove and care for the pouch.
- It is an alternative for patients looking for simplicity.
- It favors swelling abdomens because its flexibility enables adhesion and leakage prevention.
“The patient who must empty his pouch often (because of diarrhea or a new colostomy or ileostomy) may prefer a one-piece drainable disposable pouch with a closure clamp attached to a skin barrier). These transparent or opaque, odor-proof, plastic pouches come with attached adhesive or karaya seals. Some pouches have microporous adhesive. The bottom opening allows for easy draining. This pouch may be used permanently or temporarily, until stoma size stabilizes.
Also disposable and made of transparent or opaque odor-proof plastic, a one-piece disposable closed-end pouch may come in a kit with adhesive seal, belt tabs, skin barrier or carbon filter for gas release. A patient with a regular bowel elimination pattern may choose this style for additional security and confidence. […]
The selection of a pouching system should take into consideration which system provides the best adhesive seal and skin protection for the individual patient. The type of pouch selected also depends on the stoma’s location and structure, availability of supplies, wear time, consistency of effluent, personal preference, and finances.7
Disadvantages of the One-Piece Ostomy Bag
- Frequent bag changes may cause skin irritation, inflammation, sores and infection.
“Peristomal skin complications are common in patients with a stoma. The frequency ranges from 18% to 55%. There is a broad range of presentations, from mild skin irritation to ulceration and concomitant infection. The greatest risk factor is noted in patients with difficult-to-fit stomas. Often other associated stomal complications are noted, such as prolapse, retraction, and parastomal hernias. Obese patients are particularly at risk for skin complications owing to difficulty in fitting stoma appliances around body folds. These complications are more commonly seen in poorly constructed and poorly located stomas.
Mechanical, chemical, allergic and infectious causes have been identified. Most mechanical injuries occur from improper fitting or changing of an ostomy appliance. Frequent appliance changes lead to mechanical stripping of the surrounding epidermis. Painful denuded areas of skin develop, typically in the distribution of contact with adhesives. Applying a skin sealant to the damaged area can assist healing and prevent further skin striping. Pressure injuries occur from tightly fitting ostomy belts or use of convex flanges. Ulcers can form, at times full thickness, at pressure points. Movement of such devices against the skin also causes shear injury. Topical wound care products can be used to treat the damaged peristomal skin. Ideally, the offending device (ostomy belt or convex flange) should be discontinued; however, the patient may require these devices for an adequate seal.”8
- Changing the bag takes longer because the whole system requires removal. The user must place the adhesive plate accurately each time to avoid accidental leakage, which can disturb the patient when traveling or using public toilets.
Frequently changing the bag also means using skin barrier pastes and other accessories such as adhesive removers and tapes more often. These chemicals cause an increased risk of skin irritation. A natural way to prevent irritations is using medical grade Manuka honey on the adhesive plate base of the bag. The honey has anti-bacterial effects and reduces chances of skin irritation, inflammation and infection.
Patients who wear one-piece systems must consider that the pouch and skin barrier are joint, so they are easy to apply and remove. The pouch collects the stool and the skin barrier protects your skin. These pouching systems might appear not to offer patients enough options; however, most brands offer a variety of one-piece systems. Ask your ostomy nurse which one-piece ostomy bag is fitting for you.
(1) Balachandar, T. G. (2018). Stoma Care. Available online at https://books.google.co.ve/books?id=Tq52DwAAQBAJ&pg=PA110&dq=ostomy+clothing&hl=es-419&sa=X&ved=0ahUKEwiC0uGeq6viAhWSjVkKHSqwAjAQ6AEINDAB#v=onepage&q=ostomy%20clothing&f=false
(2) Lynn, P. (2010). Taylor’s Handbook of Clinical Nursing Skills. Lippincott Williams & Wilkins. Available online at https://books.google.co.ve/books?id=00x7I4hLj0IC&pg=PA664&dq=one+piece+ostomy+bags&hl=es-419&sa=X&ved=0ahUKEwjl5s-uvKziAhWG11kKHXraB1kQ6AEIQDAE#v=onepage&q=one%20piece%20ostomy%20bags&f=false
(3) Breckman, B. (Ed.). (2005). Stoma care and rehabilitation. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=F7NE_iXpEvgC&pg=PA53&dq=Disadvantages+of+the+one+piece+ostomy+bag&hl=es-419&sa=X&ved=0ahUKEwjkpcG88KziAhUvo1kKHRVOCyIQ6AEIQTAD#v=onepage&q=one%20piece&f=false
(4) Rutherford, C. (2016). Surgical Equipment and Supplies. Second Edition. Available online at https://books.google.co.ve/books?id=xK48DAAAQBAJ&pg=PA70&dq=one+piece+ostomy+bags&hl=es&sa=X&ved=0ahUKEwiCkPP-u63iAhXrzVkKHZeYB6gQ6AEIOjAD#v=onepage&q=one%20piece%20ostomy%20bags&f=false
(5) Chintamani, E. S. D. (2009). Moroney’s Surgery for Nurses, 17th edition. Noida, Elsevier Publishers. Available online at https://books.google.co.ve/books?id=GyT4-DOo020C&pg=PA180&dq=drainable+ostomy+bags&hl=es-419&sa=X&ved=0ahUKEwjfpNa406ziAhWDq1kKHSvIAQgQ6AEIMjAC#v=onepage&q=drainable%20ostomy%20bags&f=false
(6) Newman, D. K., Rovner, E. S., & Wein, A. J. (2017). Clinical Application of Urologic Catheters, Devices and Products. Springer. Available online at https://books.google.co.ve/books?id=EWdCDwAAQBAJ&pg=PA79&dq=Disadvantages+of+the+one+piece+ostomy+bag&hl=es-419&sa=X&ved=0ahUKEwjRtdPb4aziAhVxuVkKHTTYBJ8Q6AEIRzAE#v=onepage&q=one-piece&f=false
(7) Nettina, S. M., Msn, A. B., & Nettina, S. M. (2013). Lippincott manual of nursing practice. Lippincott Williams & Wilkins. Available online at https://books.google.co.ve/books?id=fhYoKc0bg-QC&pg=PA696&dq=drainable+ostomy+bags&hl=es-419&sa=X&ved=0ahUKEwj19oSh0KziAhUD2VkKHWFcBi0Q6AEIJjAA#v=snippet&q=ostomy%20bags&f=false
(8) Ramirez, P. T., Frumovitz, M., & Abu-Rustum, N. R. (2018). Principles of Gynecologic Oncology Surgery E-Book. Elsevier Health Sciences. Available online at https://books.google.co.ve/books?id=baxiDwAAQBAJ&pg=PA218&dq=Changing+the+ostomy+cause+skin+irritation+sore+skin+infection&hl=es&sa=X&ved=0ahUKEwjsx-rZsq3iAhVEp1kKHcIXDiYQ6AEIJjAA#v=onepage&q=Changing%20the%20ostomy%20cause%20skin%20irritation%20sore%20skin%20infection&f=false