Certified Wound Ostomy Nurse (CWON) Practice Test

What is the first step in pouching a fistula?

1. Apply the pouch directly

2. Cleanse the skin

3. Apply paste to the surrounding skin

4. Use a barrier ring immediately

The correct answer is: Cleanse the skin

The first step in pouching a fistula is to cleanse the skin. Proper skin cleansing is essential to remove any contaminants, fecal matter, or drainage that may be present. This helps reduce the risk of infection and ensures better adhesion of the pouching system. Clean skin promotes effective adhesion of the skin barrier and pouch, which is especially important when managing a fistula, as skin in this area may be sensitive and prone to irritation. Once the skin is clean and dry, subsequent steps, such as applying barrier paste, barrier rings, or the pouch itself, can be performed with a reduced risk of complications. This foundational step sets the stage for a successful pouching process, highlighting the importance of starting with good skin care measures.