For a patient with both GI and urinary ostomies, what is the recommended approach to mark the second ostomy relative to the first?

• A. Mark the second on the same plane as the first
• B. Mark the second on different planes if possible
• C. Mark the second in the upper left quadrant
• D. Mark the second directly over the first

Answer: (B)

Marking the second ostomy on a different plane from the first allows each stoma to sit on its own contour of the abdominal wall. This provides independent space for each appliance, so they can be cut and applied without crowding or overlapping. When ostomies share the same plane, their appliances can press against or conflict with one another, making secure attachment harder, increasing the risk of leakage, and complicating skin protection and clothing fit. If possible, position the second stoma on a different area and height of the abdomen to accommodate belts, clothing, and routine care, ensuring both appliances have their own proper clearance and contour.