I have been using a plastic clip with my ostomy pouch for years. I have heard that there are now pouches with clips attached. Are these safe to use?
Closure devices for the tails of drainable pouches have gone through a variety of changes over the years, moving well beyond the elastic bands and ‘bull-dog’ clamps used in the past. The most recent advances in closures have been the development of integrated clips: devices permanently attached to the pouch and disposed of with each pouch/appliance change. Here we will review the purposes for clips and the features of integrated clips.
Closure devices for pouches serve the primary purpose of sealing the tail of a drainable pouch, preventing stool/gas from leaking or seeping through, and allowing the user to open the system when required and convenient. Ideally, clips should provide the following additional qualities:
- Ease of use
- A secure closure
- Inhibit seepage of stool or gas
- Prevent damage to the pouch
- Discrete under clothing
- Resist breakage with frequent use
- Avoid causing trauma or discomfort.
The most commonly used clips have been separate from the pouch itself. Most of the ostomy supply companies have a version of a hard plastic reusable clip supplied with the pouches. These may be straight or slightly curved (to follow the contours of the lower abdomen/upper thigh) and should provide a secure seal with the single fold of the tail over the clip. Despite their wide use, some concerns regarding the clips remain:
- Not discrete under clothing
- Difficult to use if there are issues with hand strength and dexterity
- Sometimes uncomfortable, getting caught in skin folds or the ends ‘digging’ into skin/body parts
- Some styles may not provide secure closures
- User may drop/lose closures when emptying a pouch.
All 3 ostomy supply companies have attempted to eliminate some of the difficulties found with the traditional clips by introducing various versions of an integrated clip.
Coloplast manufactures a pouch with an EasiClose™ integrated clip that incorporates Velcro™ technology into the closure. The wider tail of the pouch is supported by thin foam, allowing it to open more easily by squeezing the sides when emptying. The tail is rolled three times, and then secured with two Velcro™ tabs; finger pressure is sufficient to ensure a closed system.
ConvaTec has the InvisiClose® system, which uses a plastic interlocking material that closes with finger pressure. There are thin end strips at the very tail of the pouch, allowing it to open more easily during emptying. The closure is rolled four times, then pressed together until you can feel the two sides “grab” each other. A single additional security flap is rolled in the opposite direction for more protection.
Lock ‘n Roll™
Hollister has the Lock ‘n Roll™ system, which uses specialized plastic fasteners. The tail of the pouch has thin strips of these closures that also allow it to be ‘pinched’ to facilitate emptying when open. The tail is rolled three times, and then finger pressure is applied to close or seal the tail.
The integrated clips undoubtedly have their benefits: they are more discrete and comfortable, require minimal hand strength/dexterity to use, and there is no fear of clip loss or breakage. However, there are some disadvantages to the integrated closures: if you are used to ‘cuffing’ the tail end of your pouch before emptying, then this method cannot be used with the integrated closures (cuffing is the technique of folding back the tail of your pouch before emptying). While it has been suggested that cleaning the tail prior to closing the system is not required (the multiple folds in the integrated closure will prevent the release of odour), some patients report anecdotally that there is some breakthrough odour, and recommend that the inside of the tail should be wiped clean before closing the tail. Some patients also feel that some of the closures (selected styles) do not cope well with liquid stool, and have described small leaks under these circumstances. Product choice may also be limited, as not all length/sizes of pouches may have these closures, and some product lines are limited to two-piece systems only.
Some people have concerns about the durability of the closures, worrying that the closure might not remain secure after multiple uses, or that the clip will fail because of material ‘fatigue.’ While product informational inserts do not indicate limitations in wear-time or frequency of clip use, ConvaTec does report that InvisiClose® can be opened/closed at least 84 times without failure of the clip.
These new integrated closures offer another option for people with their ostomy care. Ultimately, the ‘best’ clip is the one that is easy for you to use and provides a consistently secure seal. Companies offer samples of their products, so you may want to consider contacting them if you’d like to try a particular closure. Be sure to ask for an instruction sheet on the proper use of the closure system, so that you can achieve a proper seal. Your Enterostomal Therapy Nurse can also help you to decide if an integrated closure is an option for you and can show you the correct use techniques.