Patient/caregiver was educated on changing the ileostomy bag as follows:

1. A decently fixed ileostomy bag should hold good for 3 – 5 days. Many parameters, such as, skin condition & contour, amount of drainage collecting into the bag, frequency of emptying etc., could determine the duration an ileostomy bag lasts. So, plan to change the bag every 3 – 5 days or as ordered. If the bag comes loose and develops a leakage, it could be changed on an as needed basis.
2. Wafers can come in various sizes, allowing different maximum stoma sizes that you can cut on them. Some wafers could allow cut to fit a larger sized stoma and some others could allow cut to fit a stoma of smaller size. Read through your ileostomy manufacturer’s guide and pick the wafer that allows cut to fit your stoma appropriately. While picking a wafer, make sure it allows cut to fit your stoma appropriately and also has the adhesive along the edge of wafer uncompromised, which helps a good fix of the wafer to the skin around the stoma.
3. Measure your stoma appropriately & regularly, preferably on every bag change, at least during the initial few weeks of initiating on ileostomy, as the stoma size is likely to change heavily during this time. Stoma measuring guides come along with the ileostomy supplies. These measuring guides have holes of different sizes, each indicating different sized stoma. Among these many different holes cut on the stoma measuring guide, you will aptly choose the one that best matches with your stoma size. Try different holes of measuring guide by putting them around your stoma, to pick the one that is closest in measure to your stoma.
4. The back of the wafers could have cutting guides, denoting the lines of cut appropriate to the individual stoma size. If the wafer has the cutting guide and the user is pretty aware of the stoma size, one can go ahead with cutting along the defined line to make a hole on the wafer appropriate to their stoma size.
5. If the wafer is lacking the cutting guide or the user is unsure of the stoma size, then it requires some additional work of using the stoma measuring guide. After picking the hole on the stoma measuring guide that is closest in measure to your stoma, you can superimpose the hole picked on to the back of your wafer. While doing this, try superimposing the measuring guide hole picked on to the center on the back of the wafer. This allows cutting the wafer with adhesive distributed evenly around the cut. This helps a good fix of the wafer to the skin around the stoma. Presence of surgical incisions or wounds in the vicinity of the stoma mandates superimposing the measuring guide hole picked towards the corresponding edge on the back of the wafer. Even in this situation, remember not to cut the wafer completely to the edge, as it can compromise the adhesive along the edge of wafer and result in poor attachment to the skin around the stoma.
6. Using a marker you can draw a circle on the wafer, by running the marker along the periphery of the hole picked on the measuring guide. Then, you can go ahead with cutting along the line drawn on the back of the wafer, to make a hole on the wafer appropriate to your stoma size.
7. Cutting the wafer too big can result in leakage of stool on to the skin, resulting in irritation of skin and injury. This can lead to the bag coming loose resulting in accidents. Cutting the wafer too small and close to the stoma can constrict the stoma, resulting in discomfort and difficulty of stool draining into the bag, necessitating a bag change. Frequent bag changes contribute to early exhaustion of supplies and economic burden for individuals to order for replacement. Cutting the wafer/skin barrier to aptly fit the stoma is key for good attachment of the bag, prevent accidents & other complications, and longer lasting supplies. A rough measure could be cutting the wafer to an additional 1/8^th inch of stoma measurement. Using a barrier ring can also help bridge the gapbetween the edges of stoma and the wafer cut, thus preventing leakage of stool on to the skin around.
8. Do not expose the adhesive until the wafer/bag is ready to be adhered to the skin around the stoma. Apply the barrier ring at this point, remove the release liner on the adhesive, and apply the wafer or one-piece ileostomy bag on it securely in place.
9. If you are using a two piece ileostomy, connect the bag to the wafer at the flange. Two piece ileostomy bags can also come with a locking device, which helps to lock the bag and wafer together. These bags with locking device are more preferred for high-output ostomies. If your bag has a locking device, lock the bag and wafer together, which can offer more security to the two piece unit staying in place. Rotate the bag on the two piece unit to a comfortable position, as desired. Also, anchoring the belt tabs in place can offer more secure fixing of the wafer, contributing to the device holding good for longer duration and longer-lasting supplies.