Choose Your Pouch: 1 Piece vs. 2 Piece

Choose Your Pouch: 1 Piece vs. 2 Piece

By Kevin Cleary

Once the reality of living with a colostomy or an ileostomy sets in, there will inevitably be a flood of questions. What does this mean? What will I need? How will I live with this? It can be an unsettling time since so much will be unknown. Choosing which ostomy supplies will be right for you might seem like an overwhelming proposition and probably the most basic question you will need answered is which type of a pouching system will work for you and your lifestyle. While decision of which pouching system is correct for you more or less personal preference, it’s important to know the advantages and limitations of each system. The majority of ostomy pouching systems is either of the 1 or 2 piece variety and your doctor or ostomy nurse can help you decide which of these two systems might be appropriate for you.

Which Is Right for You?

It is very easy to say that choosing the correct pouching system is a matter of personal preference, but how do you choose what you prefer when you have no frame of reference to base your decision on? Each system has positives and negatives and understanding your lifestyle needs can be important. For instance, two-piece systems allow the user to change only the pouch as opposed to the entire system. This allows the wearer to easily and quickly change the pouch used based on their activity of that day. A one-piece system is simple to use and is completely remodeled every time you need to change your pouch. Both of these systems are available with closed-end and drainable pouches in order to accommodate your personal preference.

One-Piece Systems

OnePiece

For those who choose to use a one-piece system, understanding how they work is important. In a one-piece system the pouch and skin barrier are joined permanently together. The pouch collects the waste while the skin barrier hits around your stoma to protect your skin. These type of pouching systems are easy to apply and remove, while simplifying use. At first glance it might seem like these type of pouching systems might not offer patients a variety of choices, but each manufacturer produces quite the wide variety of one-piece systems. For instance, Hollister offers the Karaya 5 Convex Pre-Sized Pouch with Belt Tabs as well as the Karaya 5 Closed Pouch with Porous Tape. Many other manufacturers produce different variants of their one-piece. Marlen offers patients the UltraLite Deep Convex Pouches with Skin-Shield Barrier as well as the UltraLite Deep Convex Transparent Pouches with Skin Shield Barrier. It’s the subtle differences that can make a world of difference in each individual patient. What might work for one patient, might not be comfortable or appropriate for another. While some people view these differences are minor, to some it could mean all the difference in the world. Some ostimates may prefer to have pouches that have a clear material for visibility. Schena offers users the EZ-Clean Drainable Pouch in both clear and opaque material. One option for those that choose a one-piece system is the Coloplast Assura. They offer many different options so finding one that will work for you should not be a problem. They offer a spiral structure adhesive which is made from two different adhesives rolled into one, therefore providing optimal adhesion and security due to its skin friendly nature of the adhesive. They offer varieties that include filters, convex/non-convex, and cut to fit or precut pouching systems.

Two-Piece Systems

TwoPiece

While a one-piece system offers a simple easy to use system, a two-piece system offers the wearer some options and flexibility. Unlike a one-piece system, this type of system requires the ostimate to only change the ostomy bag and not the skin barrier wafer. They can then clean the pouch and reattach it or just discard the soiled pouch and attach a brand-new one. This allows an ostomy patient to quickly and easily switch the type of pouch they’re using to match their current activity. Manufacturers such as ConvaTec offer products such as the Esteem or their SUR-FIT (both the Natura and the Autolock) systems that have enough options for a custom fit for most patients. Hollister offers ostomy patients a couple of options with their New Image two-piece system as well as their CenterPointLock systems. Both offer the user convex and flat skin barrier wafers and secure attachment of pouches. According to o-wd.com, the choice of a smaller closed end pouch may be more desirable during sexual activity or during periods of minimal stoma output whereas the choice of a drainable pouching system might be more desirable at night or at work to increase capacity. The author of that article, Gwen Turnbull RN, also states that two-piece pouching systems require a lighter pressure for pouch attachment therefore making it easier for sensitive post operative abdomens and reduce discomfort. This makes a pouch change more pain-free and encourages earlier participation in self-care. One manufacturer, Coloplast, makes things easy with their Assura AC Two-Piece Systems. Their coupling system is color-coded and the barrier color must match the pouch color and are available with or without filters to improve odor control. The Coloplast Assura Two-Piece Systems utilizes a unique transparent spiral adhesive that provides the user with security and flexibility while protecting surrounding skin. While this adhesive has dual roles it allows the pouch to be changed more frequently than the barrier and offers the wearer the ability to choose from standard or extended wear barriers and transparent or opaque pouches.

Drainable or Closed End Pouches?

One choice that ostomy patients face is whether or not to use a drainable or closed end pouch. The choice to choose one of the other can be purely a personal preference. The drainable pouch is one that can be removed, cleaned, and then reattached. The closed-end pouch requires the user to completely discard the used pouch and replace it with a completely new one. The reusable, drainable pouch has an upside in that it cuts down on costs since one pouch can be reused more than once, while a closed end pouch may be more desirable to someone who does not want to have to clean out their pouch. Patients should talk to their doctors or ostomy nurses to help determine what might work best for their activities and lifestyle.

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