Why Two-Piece Drainable Systems with Flexible Adhesive Coupling for Ostomy Management

Two-piece ostomy systems revolutionize daily management by separating the skin barrier (baseplate) from the collection pouch, allowing pouch changes without disturbing the adhesive seal against peristomal skin. This design is particularly beneficial for ostomates with sensitive, damaged, or fragile peristomal skin who experience irritation, redness, or breakdown from frequent adhesive removal. The Harmony Duo system takes this concept further with a flexible adhesive coupling mechanism that creates secure attachment while conforming to body contours and movement—critical for maintaining seal integrity during bending, sitting, exercising, and daily activities.

The 13–50 mm cut-to-fit starter hole accommodates a wide range of stoma sizes and shapes, making this system versatile for both new ostomates whose stoma size is still changing (stomas typically shrink during the first 6-8 weeks post-surgery) and established ostomates with stable stoma dimensions. Custom cutting ensures the skin barrier opening matches the stoma precisely, leaving minimal exposed peristomal skin vulnerable to corrosive stoma output—the primary cause of peristomal skin complications affecting 45-75% of ostomates. Proper fit is especially critical for ileostomy and colostomy output, which contains digestive enzymes that rapidly damage exposed skin, causing painful erosion, ulceration, and infection within hours of contact.

The drainable outlet design extends wear time by allowing users to empty the pouch multiple times before changing it entirely—typically 2-3 days for the pouch versus 3-5 days for the baseplate. This approach reduces supply costs (fewer pouches needed), decreases skin trauma from adhesive removal, and provides convenience for active lifestyles. For ileostomy users who produce 800-1200ml of liquid output daily, or colostomy users with high-volume formed output, drainable systems prevent the need for 4-6 complete system changes per day that would be required with closed pouches. The integrated closure system ensures secure sealing between emptying sessions, preventing leaks and odor release.

Large-capacity pouches address the unique needs of high-output ostomates, nighttime wear, and situations where frequent emptying is impractical (long meetings, travel, sleeping). The opaque material provides visual discretion—eliminating the anxiety many ostomates experience about visible stoma output showing through clothing—while maintaining the ability to check pouch fullness by feeling rather than viewing. This privacy feature is consistently rated as a top priority by ostomates, particularly those returning to work, social activities, or intimate relationships after surgery.

The Harmony Duo's flexible adhesive coupling creates a gentler connection point compared to rigid snap-ring systems. Flexible couplings accommodate body contours, reduce pressure points that cause discomfort or skin damage, and maintain seal integrity during movement. This design is especially valuable for ostomates with uneven abdominal terrain (scars, creases, hernias), those who are overweight or underweight (where body contours create sealing challenges), and active individuals whose movement would stress rigid coupling systems.

Key Features

• Two-piece system design – baseplate (sold separately) and pouch separate for skin-friendly changes
• Harmony Duo adhesive coupling – flexible connection mechanism for secure, comfortable attachment
• 13–50 mm cut-to-fit starter hole – accommodates wide range of stoma sizes and shapes
• Large-capacity drainable pouch – extended wear between changes with multiple emptying capability
• Opaque pouch material – provides visual privacy and discretion under clothing
• Integrated closure system – secure outlet closure prevents leaks and odor between emptying
• Soft backing material – gentle against skin for all-day comfort
• Drainable outlet design – allows emptying without removing entire pouch
• Box of 30 pouches – one to two-month supply depending on change frequency
• Compatible with Salts Harmony Duo baseplates – works with corresponding adhesive baseplate system

Benefits

• Reduces peristomal skin trauma by allowing pouch changes without baseplate removal
• Custom cut-to-fit design minimizes exposed skin and reduces leakage risk
• Flexible coupling accommodates body movement and contours for reliable seal
• Drainable design extends wear time to 2-3 days per pouch, reducing supply costs
• Large capacity handles high-volume output for ileostomy and colostomy users
• Opaque material provides confidence and privacy in social and professional settings
• Multiple emptying capability supports convenience during work, travel, or sleep
• Gentle adhesive coupling reduces pressure points and discomfort
• Suitable for ostomates with sensitive or compromised peristomal skin
• Cost-effective supply use—change pouch 2-3 times per baseplate change

Clinical Applications

✓ Colostomy management requiring drainable, high-capacity pouching
✓ Ileostomy with high-volume liquid output (800-1200ml+ daily)
✓ Ostomates with sensitive or damaged peristomal skin benefiting from reduced adhesive changes
✓ New ostomates with changing stoma size during post-surgical healing (6-8 weeks)
✓ Established ostomates with stable stoma dimensions in 13-50mm range
✓ Active individuals requiring flexible coupling for movement and exercise
✓ Nighttime wear requiring high-capacity storage without frequent emptying
✓ Professional/work settings where frequent pouch changes are impractical
✓ Travel situations requiring extended wear between changes
✓ Ostomates with irregular body contours (hernias, scars, creases) needing flexible seal
✓ Users transitioning from one-piece to two-piece systems for skin protection
✓ Loop or end stomas producing moderate to high output volumes

Usage & Application

Pre-Application Assessment

Stoma Measurement: Measure your stoma size accurately before cutting the baseplate opening. Stomas typically shrink during the first 6-8 weeks post-surgery, so re-measure weekly during this period. Once stable (usually 8-12 weeks post-op), measure monthly to detect any changes. Use the measuring guide provided with your supplies or a stoma measuring card.

Stoma Shape Assessment: Note whether your stoma is round, oval, or irregular. The cut-to-fit design accommodates all shapes. For oval stomas, you'll create an oval opening. For irregular shapes, cut conservatively and trim as needed to match stoma contours precisely.

Baseplate Status Check: This pouch requires a Salts Healthcare Harmony Duo baseplate (sold separately). Ensure your current baseplate is clean, dry, and the adhesive is securely attached to your skin. If the baseplate shows signs of lifting, leaking, or has been in place for more than 3-5 days, change the baseplate before applying a new pouch.

Pouch Selection: Confirm this large-capacity drainable pouch is appropriate for your output type and volume. This pouch is ideal for ileostomy (liquid output) and colostomy (formed output) when extended wear between emptying is desired. If you have very low output or prefer more frequent complete changes, closed pouches may be more suitable.

Gather Supplies

• Salts Healthcare Harmony Duo drainable pouch (this product)
• Salts Healthcare Harmony Duo baseplate (if changing baseplate)
• Stoma measuring guide or template
• Scissors (dedicated for cutting ostomy supplies only)
• Pen or marker for tracing
• Clean washcloth or gauze pads
• Warm water
• Mild soap (optional, unscented)
• Paper towels or soft towel
• Waste disposal bag
• Mirror (optional, helpful for visualization)

Baseplate Preparation (If Applying New Baseplate)

When to Change Baseplate: Change the baseplate every 3-5 days or immediately if:

• Adhesive is lifting or loose
• Leakage is occurring
• Skin irritation develops
• Baseplate feels uncomfortable or shows wear
• You notice itching or burning under the baseplate

Removing Old Baseplate:

1. Empty and remove the current pouch
2. Press down on skin with one hand while gently peeling baseplate away with the other
3. Use adhesive remover wipes if needed to dissolve stubborn adhesive
4. Peel slowly to minimize skin trauma—never rip baseplate off quickly

Skin Cleansing:

1. Wash peristomal skin with warm water using washcloth or gauze
2. Use mild, unscented soap if desired (avoid oils, lotions, or scented products)
3. Pat dry thoroughly—moisture prevents adhesive bonding
4. Inspect skin for redness, irritation, breakdown, or damage
5. Address any skin issues before applying new baseplate (consult ostomy nurse if concerns)

Measuring and Cutting Baseplate:

1. Measure stoma at its widest points (horizontally and vertically for oval stomas)
2. Add 1-3mm (1/8 inch) to the measurement—you want the opening to clear the stoma without touching it, but not leave excessive exposed skin
3. Trace the measured size onto the baseplate's starter hole guide using the template or measuring guide
4. Cut carefully with scissors along the traced line
5. Smooth any rough edges with your finger—rough edges can damage the stoma
6. Test-fit the cut opening against your stoma (without removing adhesive backing) to ensure proper size

Baseplate Application:

1. Stand or lie in position that smooths abdominal skin where baseplate will be placed
2. Remove adhesive backing from baseplate
3. Warm baseplate in your hands for 30-60 seconds to activate adhesive
4. Center the cut opening over the stoma
5. Press firmly from the center outward, smoothing baseplate onto skin to eliminate air pockets and wrinkles
6. Apply gentle pressure to entire baseplate for 60 seconds to ensure secure bond
7. Some ostomates prefer to wait 1-2 minutes after baseplate application before attaching pouch (allows adhesive to fully bond)

Pouch Application (With Baseplate Already in Place)

Remove Old Pouch: If changing pouches while keeping the same baseplate:

1. Empty the current pouch completely before removal
2. Locate the adhesive coupling connection point between pouch and baseplate
3. Gently peel or lift the pouch away from the baseplate coupling
4. The Harmony Duo system uses adhesive coupling—peel pouch away steadily but gently
5. Dispose of used pouch in waste bag

Clean Baseplate Coupling: Wipe the baseplate coupling surface with dry tissue or gauze to remove any residue or moisture. Ensure the coupling surface is clean and dry for secure attachment of the new pouch.

Prepare New Pouch:

1. Remove new drainable pouch from packaging
2. Ensure the drain outlet is closed securely using the integrated closure system (clamp, fold-and-secure, or other closure type depending on model)
3. Inspect pouch for any defects before application

Attach Pouch to Baseplate:

1. Align the pouch's coupling ring with the baseplate's coupling ring
2. The Harmony Duo adhesive coupling requires pressing the pouch firmly onto the baseplate
3. Starting at the top (12 o'clock position), press the pouch coupling onto the baseplate coupling
4. Work your way around the coupling in both directions until the entire ring is securely attached
5. You should feel or hear when the coupling is fully seated (some systems click or snap)
6. Gently tug on the pouch to ensure secure attachment—it should not pull away from baseplate
7. If any area feels loose, press firmly again until secure connection is achieved

Outlet Position: Position the pouch so the drainable outlet faces downward and is easily accessible for emptying. The pouch should hang naturally without twisting or kinking.

Emptying the Drainable Pouch

Emptying Frequency: Empty the pouch when it's approximately 1/3 to 1/2 full. Waiting until the pouch is too full increases risk of:

• Seal failure or leakage due to excessive weight
• Uncomfortable bulging and clothing show-through
• Difficult emptying due to thick output
• Coupling separation from pouch weight

Emptying Procedure:

1. Sit on toilet or stand over toilet (depending on personal preference and mobility)
2. Hold the bottom of the pouch over the toilet
3. Open the closure system (unclasp, unroll, or open depending on design)
4. Allow contents to drain into toilet by gentle pressure or gravity
5. For thick output, you may need to gently massage the pouch from top to bottom to encourage flow
6. Once empty, clean the inside tip of the outlet with toilet paper
7. Secure the closure system firmly to prevent leakage
8. Wash hands thoroughly

Emptying Tips:

• Empty before eating meals (when output is typically slower) for cleaner emptying
• If output is very thick, try emptying while sitting so gravity assists drainage
• Carry small bottle of water to rinse outlet if needed when away from home
• Fold a small amount of toilet paper around outlet tip before closing to absorb residual output
• For ileostomy output (liquid), emptying is typically easier than colostomy (formed), which may require more coaxing

Pouch Wear Time

Recommended Change Frequency:

• Pouch: Change every 2-3 days or sooner if:
  • Pouch film develops odor that doesn't resolve after emptying
  • Pouch shows signs of wear, tears, or film breakdown
  • Coupling begins to feel loose or unreliable
  • Personal preference for more frequent changes
• Baseplate: Change every 3-5 days or sooner if:
  • Adhesive begins lifting or loosening
  • Leakage occurs
  • Skin irritation develops under baseplate
  • Baseplate edges curl or roll
  • Itching or burning sensation under baseplate

Maximizing Wear Time:

• Empty pouch regularly (at 1/3 to 1/2 full) to reduce weight stress on coupling
• Avoid excessive sweating or water exposure when possible (or plan changes after swimming/bathing)
• Support pouch when dressing/undressing to prevent pulling on coupling
• Avoid tight clothing that creates excessive pressure on pouching system

Monitoring and Skin Care

Daily Checks:

• Inspect coupling connection each morning to ensure pouch is securely attached
• Feel around baseplate edges to detect any lifting
• Check for unusual odor, which may indicate seal failure or skin breakdown
• Monitor pouch fullness and empty before it becomes too heavy

Peristomal Skin Assessment: Each time you change the baseplate:

• Examine skin for redness, irritation, rash, or breakdown
• Healthy peristomal skin should look like the skin on the rest of your abdomen
• Report any persistent redness, open areas, bleeding, or pain to ostomy nurse
• Document any skin changes and what might have caused them

Skin Protection:

• Ensure accurate stoma sizing—opening should clear stoma with only 1-3mm gap
• Address leaks immediately—even small leaks cause skin damage quickly
• Consider barrier paste, rings, or powder if minor irritation develops
• Maintain proper pouch emptying schedule to prevent overfilling and leaks

Troubleshooting

Problem: Pouch keeps separating from baseplate

• Solution: Ensure baseplate coupling surface is clean and dry; make sure you're pressing firmly around entire coupling ring when attaching; check that baseplate itself is still securely adhered to skin (if baseplate is loose, pouch won't stay); avoid overfilling pouch which creates excessive weight; may need to change baseplate more frequently

Problem: Leakage occurring around baseplate

• Solution: Check stoma size—may have changed requiring different baseplate opening size; ensure cut opening matches stoma shape accurately; consider convex baseplate if stoma is flush or retracted; use barrier paste or sealing strips around stoma edge; change baseplate more frequently; consult ostomy nurse if persistent

Problem: Skin irritation or redness around stoma

• Solution: Verify opening size—exposed skin contacting output causes irritation; change baseplate more frequently; use skin barrier powder for minor irritation; check for allergic reaction to adhesive (rare but possible); ensure complete drying of skin before baseplate application; see ostomy nurse if irritation persists

Problem: Difficulty emptying thick output

• Solution: Empty more frequently before output thickens; increase fluid intake to thin output consistency; gently massage pouch from top to bottom during emptying; try different emptying positions (sitting vs standing); consider adding small amount of water to pouch after emptying to prevent residue buildup

Problem: Odor escaping from pouch

• Solution: Check that drain outlet closure is fully secured; inspect pouch film for any small tears or holes; change pouch more frequently if film is breaking down; avoid foods known to increase odor (garlic, onions, fish, eggs); consider using pouch deodorizers if desired; ensure coupling seal is complete with no gaps

Problem: Pouch too visible under clothing

• Solution: This opaque pouch should minimize visibility; try positioning pouch horizontally or at angle when attaching rather than straight down; consider high-waisted clothing or specialized ostomy underwear; empty pouch more frequently to reduce bulging; explore different pouch sizes or shapes

Problem: Coupling difficult to attach or uncomfortable

• Solution: Ensure baseplate and pouch coupling are compatible (both Harmony Duo system); clean coupling surfaces before attaching; press firmly and systematically around entire ring; if coupling creates pressure or discomfort, may need different baseplate size or style; consult with ostomy nurse

Problem: Baseplate lifting or rolling at edges

• Solution: Skin may not have been completely dry during application; try extending wear time with barrier extenders or tape around edges; change baseplate more frequently; use skin prep wipe before baseplate application to improve adhesion; address sweating issues; consider different baseplate size or adhesive type

Special Considerations

For New Ostomates: Expect a learning curve of 2-4 weeks as you master pouch application and management. Your stoma will change size during the first 6-8 weeks post-surgery—measure weekly and adjust baseplate cutting accordingly. Don't be discouraged by early challenges with leakage or fit—most ostomates achieve reliable management with practice and product adjustments.

For High-Output Ileostomy: You may need to empty this large-capacity pouch 4-8 times daily depending on your output volume. Monitor for dehydration (dark urine, dizziness, fatigue) and discuss with your healthcare team if output exceeds 1500ml daily. Consider high-output pouches with even larger capacity if standard size becomes impractical.

For Active Individuals: The flexible Harmony Duo coupling is designed for movement, but you may want to secure the pouch with ostomy belt or binder during vigorous exercise for additional support. Empty pouch before exercise to reduce weight. Swimming is generally safe with two-piece systems—just ensure baseplate adhesive has fully bonded (wait 1-2 hours after application).

For Nighttime Wear: The large capacity is designed for overnight use. Empty immediately before bed. Consider connecting to bedside drainage bag if output is extremely high overnight. Some ostomates sleep with towel over pouch area for peace of mind, though well-applied systems rarely leak.

For Travel: Pack 2-3x your expected supply needs to account for unexpected changes. Carry supplies in carry-on luggage when flying (never check ostomy supplies). Pre-cut several baseplates at home if traveling without scissors. The drainable system is ideal for travel since you can empty without complete changes.

For Ostomates with Hernias or Irregular Abdomens: The flexible coupling accommodates body contours better than rigid systems, but hernias may still present challenges. Consider convex baseplates if stoma retracts into hernia. Use hernia support belts as recommended by ostomy nurse. Monitor coupling security carefully as hernias can create movement that stresses the connection.

For Intimacy: Empty pouch completely before intimate activity. The opaque design provides discretion. Consider smaller-capacity pouches for these situations if preferred. Many ostomates use ostomy wraps or cummerbunds for additional confidence. The two-piece system allows keeping baseplate in place while changing to smaller/less visible pouch.

Storage

Store unopened pouches in a cool, dry location at room temperature (59-86°F / 15-30°C). Avoid extreme heat (car trunks in summer) or humidity (bathrooms) which can affect adhesive quality. Check expiration dates on packaging and use oldest supplies first. Proper storage extends product shelf life to the full expiration date (typically 3-5 years from manufacture).

When to Contact Your Ostomy Nurse

Seek professional guidance if you experience:

• Persistent leakage despite proper technique and fit
• Peristomal skin breakdown, ulceration, or infection
• Stoma color changes (dusky, dark, black) indicating circulation problems
• Stoma bleeding (beyond minor surface bleeding with cleaning)
• Stoma retraction, prolapse, or significant size changes
• Inability to achieve secure coupling attachment repeatedly
• Allergic reaction to adhesive (severe redness, itching, blisters)
• Difficulty managing high output volumes
• Hernia development around stoma site
• Questions about product selection or technique improvement
• Significant anxiety or depression related to ostomy management

Technical Specifications

• Brand: Salts Healthcare
• Product Line: Harmony Duo
• System Type: Two-piece ostomy system (baseplate sold separately)
• Pouch Style: Drainable with integrated closure system
• Capacity: Large (exact volume may vary by model, typically 400-500ml+)
• Opacity: Opaque (non-transparent) for privacy
• Starter Hole Range: 13–50 mm cut-to-fit
• Coupling Mechanism: Flexible adhesive coupling (Harmony Duo)
• Backing Material: Soft, skin-friendly
• Outlet Style: Drainable with integrated secure closure
• Filter: Check product packaging for filter presence (odor and gas management)
• Quantity per Box: 30 pouches
• Supply Duration: Approximately 1-2 months (depending on change frequency of 2-3 days per pouch)
• Stoma Types: Suitable for colostomy and ileostomy
• Baseplate Compatibility: Requires Salts Healthcare Harmony Duo adhesive baseplate (sold separately)
• Material: Medical-grade ostomy film (latex-free, skin-safe)
• Intended User: Adult ostomates with stomas measuring 13-50mm
• Storage: Room temperature, dry location
• Shelf Life: Check packaging for expiration date (typically 3-5 years from manufacture)