Measure the stoma size with the measuring guide provided. Trace the exact stoma size onto the center white release paper of the skin barrier. The small starter hole should be in the center of your tracing. For skin barriers with pre-cut stoma openings: Select a pouching system with a pre-cut stoma opening the same size as the largest diameter of the stoma. Do not enlarge the pre-cut stoma opening. 2. Important: Before cutting, separate the front and back panels to avoid cutting through the pouch. Make sure that the inner surfaces of the pouch are separated and that the pouch contains a small amount of air. Cut along the tracing with curved, shortblade scissors. 3.Cut the center hole the same size as the stoma, using the guidelines on the release paper. Do not cut beyond the last line. 4. Remove white release paper from the skin barrier. Leave the outer release paper on the tape collar in place. 5. A caulking material, such as Stomahesive Paste, can be applied to the back of the skin barrier to further fill gaps between the wafer and the stoma. Allow the paste to set for one minute prior to application to the skin. (Do not spread the paste.). 6. Place the pouching system gently in position over the stoma. Press the skin barrier against the skin, paying particular attention to the area closest to the stoma. 7. During application, maintain gentle pressure on the skin barrier for 30 seconds to improve adhesion. 8. After the skin barrier is in place, remove one side of the release paper on the tape collar and smooth onto the skin, working from the center out to the edges. 9. Repeat with the other side, making sure the tape is smooth and wrinkle free.