The Big Picture
Sometimes the bladder is surgically removed because of cancer or a bladder injury. The body still needs a way for urine to leave, so surgery creates a new pathway.
A ureterostomy creates an opening between a ureter and the abdomen. An ileal conduit uses part of the small intestine to create an artificial bladder. In both cases, urine leaves the body through an opening called a stoma and drains into a pouch.
Good skin care matters because urine and the pouch adhesive can irritate or damage the skin around the stoma.
Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.
Quick tip: Tap, click, or press Enter on any term with a dotted underline and an ⓘ icon to see its plain-English definition.
Start Here If You’re Overwhelmed
Focus on these core ideas:
- A ureterostomy is an artificial opening between a ureter and the abdomen.
- An ileal conduit is an artificial bladder made from part of the ileum.
- Urine drains through a stoma into an ostomy appliance, often called a pouch.
- Protect the skin around the stoma and report and record skin changes.
- Follow the correct order when changing the pouch, including hand hygiene, skin care, observation, safe pouch placement, and post-procedure care.
- The client should assist with care as much as possible.
Jump to:
Course Notes: Key Ideas You Need to Know
Why a New Urine Pathway May Be Needed
The bladder is sometimes surgically removed as part of treatment for cancer or bladder injuries.
Urine still needs a way to leave the body. Surgery creates a new pathway called a urinary diversion.
Urinary diversions come in different types. The most common is an ostomy, which is the surgical creation of an artificial opening.
Ureterostomy
A ureterostomy is an artificial opening between a ureter and the abdomen.
The opening on the abdomen is called a stoma. A stoma is a surgically created opening from part of a body cavity to the outside.
Stomas do not have nerve endings, so the stoma itself is not painful.
Ileal Conduit
An ileal conduit is an artificial bladder made from a section of the ileum, which is part of the small intestine.
Urine drains from the ureters into this artificial bladder. It then leaves through the stoma.
The Ostomy Appliance or Pouch
An ostomy appliance is a disposable plastic bag that sticks to the skin around the stoma. Some people call it a pouch.
Urine drains into the pouch.
The pouch must be replaced when it leaks. Leaking urine can cause:
- skin irritation
- skin breakdown
- infection
- concern about odour
- embarrassing wetness
Skin Care Around the Stoma
Providing good skin care is your responsibility when caring for a client with a ureterostomy.
The skin around the stoma is at risk for breakdown from:
- draining urine
- adhesive from the ostomy appliance
Report: Changes in the skin around the stoma.
Document: Changes in the skin around the stoma.
Client Participation and Quality of Life
Immediately after this type of surgery, a nurse provides the client’s care. A support worker may later care for a client with a long-standing ureterostomy.
The client should help with care as much as possible.
Advocate for the client’s quality of life by promoting:
- dignity
- independence
- individualized care
- preferences
- privacy
- safety
Nova Scotia CCA Note
Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition teaches that a support worker may care for clients with long-standing ureterostomies. In Nova Scotia, the current Continuing Care Assistant Occupational Standards of Practice specifically lists providing ostomy care under the Personal Care competency area. (novascotiacca.ca)
This does not mean every CCA performs ostomy care automatically in every workplace. The care must fit the CCA’s occupational standards and the employer’s scope of employment and policies. The required practice conditions must also be in place, including an identified intervention, appropriate training, competence, documentation, and instructions. Competency verification might also be required depending on the situation. (novascotiacca.ca)
Why this matters in Nova Scotia: Knowing the pouch-changing procedure is only one part of the role. The CCA must also meet the provincial practice requirements and the employer’s requirements before providing the care.
Official source: Continuing Care Assistant Occupational Standards of Practice (CCA OSoP)
Last checked: September 22, 2026
Urinary Output
Urinary output means the amount of urine a person excretes.
The care plan determines whether urinary output is measured and recorded:
- after every hour
- at the end of each shift
- at the end of each day
- not at all
Equipment for Changing a Ureterostomy Pouch
Collect the needed equipment before starting. Having everything ready prevents unnecessary trips away from the client and reduces wasted time and energy.
Collect:
- clean pouch with skin barrier
- separate skin barrier, if needed
- pouch clamp, clip, or wire closure
- clean ostomy belt, if used
- four to eight 5 × 5 cm (2 × 2 in.) gauze squares
- adhesive remover
- cloth for applying adhesive remover
- bedpan with cover
- waterproof pad
- cover or bath blanket, if available
- toilet tissue
- wash basin
- bath thermometer
- soap or cleansing agent according to the care plan
- pouch deodorant
- paper towels
- gloves
- disposable bag
Changing a Ureterostomy Pouch
The steps need to stay in the correct order.
Pre-Procedure
- Identify the client according to employer policy . This prevents mistaking one client for another.
- Explain the procedure to the client.
- Practise proper hand hygiene.
- Collect all required equipment.
- Arrange paper towels on the work area. Place the equipment on the paper towels.
- Provide privacy.
- Raise the bed to a comfortable working height.
Removing the Used Pouch
- Lower the bed rail near you if it is up. The procedure may also be done while the client sits on the toilet if the client can sit without assistance for the needed length of time and both the client and support worker prefer this position.
- Cover the client with a cover or bath blanket if one is available. Fan-fold the bed linen to the foot of the bed.
- Place the waterproof pad under the client’s buttocks to absorb urine or water that may drip.
- Put on gloves.
- Disconnect the pouch from the belt. Remove the belt.
- Gently remove the pouch by pushing the skin down and away from the skin barrier if the barrier is separate. Place the pouch in the bedpan. Being gentle reduces the risk of injuring the stoma or surrounding skin and makes the procedure more comfortable for the client.
- Place one or two gauze squares over the stoma to absorb urine that may drain during the procedure.
- Wipe around the stoma with toilet tissue or a gauze square. Put soiled tissue in the bedpan and used gauze in the disposable bag.
- Apply adhesive remover to a cloth. Clean around the stoma to remove remaining skin barrier. Clean from the stoma outward. Always wipe from clean to dirty.
Measuring and Observing the Urine
- Cover the bedpan and take it to the bathroom. If bed rails are used, raise them before leaving the bedside.
- Measure the urine. Report any abnormality. Note the urine’s colour, clarity, and odour. Empty the pouch and bedpan into the toilet, then place the used pouch in the disposable bag.
- Remove gloves. Practise proper hand hygiene. Put on clean gloves.
Cleaning and Checking the Skin
- Fill the wash basin with warm water. Measure the water temperature with a bath thermometer and check the care plan for the correct temperature. Place the basin on paper towels in the work area. Lower the bed rail near you if it is up.
- Clean the skin around the stoma with water and soap or another cleansing agent according to facility policy. Rinse the skin and pat it dry. This decreases the risk of pathogen spread.
- Observe the stoma and the surrounding skin. Report any skin irritation or breakdown.
Urine that collects around the stoma can cause skin irritation and soreness.
Applying the New Pouch
- Apply the skin barrier if it is a separate device. Follow the care plan for the correct appliance and equipment.
- Put on a clean ostomy belt if the client wears one.
- Add deodorant to the new pouch.
- Remove the adhesive backing from the pouch.
- Remove the gauze square used to absorb urine from the stoma. Put it in the disposable bag.
- Centre the pouch over the stoma with the drain pointing downward. This position allows urine to drain away from the stoma.
- Press around the skin barrier. Apply gentle pressure from the stoma outward to help seal the pouch to the skin.
- Maintain pressure for 1 to 2 minutes. This allows the backing to warm to body temperature and helps activate the seal.
- Connect the belt to the pouch if the client wears one.
- Remove the waterproof pad.
- Remove gloves and practise proper hand hygiene.
- Cover the client.
Post-Procedure Care
- Provide for the client’s safety and comfort.
- Place the call bell within reach so the client has an easy, safe way to contact staff if needed.
- Return the bed to its lowest position. Follow the care plan for bed rail use. Returning the bed to its lowest position reduces the risk of client injury.
- Remove privacy measures.
- Put on gloves and clean the bedpan, wash basin, and other equipment.
- Return equipment to its proper place.
- Discard the disposable bag according to employer policy. Follow employer policy for handling soiled linen.
- Remove gloves and practise proper hand hygiene.
Some steps involving the bed, bed rails, or call bell may not apply in community settings.
What to Report and Record
Report and record your:
- actions
- observations
- basic assessments
Follow employer policy.
These details are reported and recorded for legal reasons and to keep the rest of the health care team informed.
Important observations during the procedure include:
- abnormalities in the urine
- urine colour
- urine clarity
- urine odour
- skin irritation
- skin breakdown
Nova Scotia CCA Note
Sorrentino uses the broad phrase “basic assessments.” Current Nova Scotia standards use the more specific term observational point of care assessment for the observations a CCA makes before, during, and after providing care. This includes watching for changes in the person’s condition, situation, skin integrity, and environment. (novascotiacca.ca)
A CCA observational assessment is not a nursing assessment. It does not authorize the CCA to perform the comprehensive evaluation used to make clinical decisions or develop care-planning interventions. The CCA observes, follows the care plan, and recognizes when a change needs to be escalated to a supervisor. (novascotiacca.ca)
Why this matters in Nova Scotia: For CCA study and practice, keep observation and escalation separate from the comprehensive assessment performed by a regulated health care professional.
Official source: Continuing Care Assistant Occupational Standards of Practice (CCA OSoP)
Last checked: September 22, 2026
Exam Clue Words
- Report: Report abnormalities in the urine and any skin irritation or breakdown.
- Follow the care plan: Use the care plan for water temperature, cleansing products when specified, the correct appliance and equipment, and bed rail use.
- According to employer policy: Follow employer policy for client identification, disposal, handling soiled linen, reporting, and recording.
- If used or if worn: An ostomy belt and some related steps apply only when the client uses a belt.
Fast Review
Keep these points in mind when you need a quick review:
- A urinary diversion provides a new pathway for urine after the bladder is removed.
- A ureterostomy creates an artificial opening between a ureter and the abdomen.
- An ileal conduit is an artificial bladder made from part of the ileum.
- A stoma is the surgically created opening to the outside of the body.
- Urine drains into an ostomy appliance, or pouch, attached around the stoma.
- Replace a leaking pouch because urine leakage can irritate and damage the skin and contribute to infection.
- Observe the stoma and surrounding skin. Report skin irritation or breakdown.
- Measure urine when required and note its colour, clarity, and odour.
- Clean around the stoma from the stoma outward, wiping from clean to dirty.
- Centre the new pouch over the stoma with its drain pointing downward.
- Hold gentle pressure around the skin barrier for 1 to 2 minutes.
- Report and record actions, observations, and basic assessments according to employer policy.
Final Pep Talk
This topic has many steps, so study it in sections instead of trying to hold all 42 steps in your head at once. Review the setup, pouch removal, skin care, new pouch placement, and post-procedure care as separate parts, then practise putting them back in order.