Need help with Ostomy patient

Specialties Wound

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Specializes in Wound Care, Infusion, ER, HH.

I have a female pt. who was just admitted to my Home Care Agency from another Home Care Agency. She had a colostomy done on her in Dec. 07. Right now, it is an angry red all around the opening. Looks like an abrasion all around it. She complains of a burning sensation, esp. when the bag is being changed and the stoma is getting cleaned. She only changes it q 6-7 days, I instructed her to change it q 2 days. But what can she use to heal? We don't have an ET nurse in our agency.

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Specializes in LTC/hospital, home health (VNA).

I have seen good results with microguard powder then set with non-sting barrier then use a extra thin Duoderm over the irritated areas before using the stoma paste, stomahesive, skin prep, eakins, etc then the ostomy appliance. Hope you find something that works!

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Yes, some kind of stoma powder and sting-free skin prep will help. Sprinkle the powder around the irritated area and then brush it off with a 4 x 4. This helps to set the powder into the skin. Then lightly dab it with the skin prep.

I agree with the duoderm. It will help protect the skin from the effluent and allow it to heal.

The biggest thing you can do is figure out why she is leaking. It could be that her appliance is breaking down or maybe her stoma has shrunk and/or the contour of her abdomen has changed. If this is the case then she may need a different appliance. Can you describe her ab and stoma?

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Specializes in Wound Care, Infusion, ER, HH.
Yes, some kind of stoma powder and sting-free skin prep will help. Sprinkle the powder around the irritated area and then brush it off with a 4 x 4. This helps to set the powder into the skin. Then lightly dab it with the skin prep.

I agree with the duoderm. It will help protect the skin from the effluent and allow it to heal.

The biggest thing you can do is figure out why she is leaking. It could be that her appliance is breaking down or maybe her stoma has shrunk and/or the contour of her abdomen has changed. If this is the case then she may need a different appliance. Can you describe her ab and stoma?

She has had multiple abdominal surgeries with more to come. The stoma is irregularly shaped, it is a transverse colostomy on her right side. Unfortunately, I'm not an ET nurse, so I'm not sure how else to describe it.

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Well, I have a couple of thoughts of what might be going on. 6-7 days w/ a transverse is a long time. It may be that her appliance is degrading and allowing her to leak underneath of it. If that is it then just decreasing her wear time may solve the problem.

If her stoma has shrunk or changed sometimes an appliace change is warranted. One thing to look for is if the stoma is recessed instead of sticking out. If it is then she needs some type of convexity appliance. It helps the stoma to ' pop' out better.

If her abdomen has dips and bends then you need to try something that will help you have a flat 'working surface' on which to place the appliance.

I would say, right now, try the powder and skin prep suggestion along with not waiting so long to change the bag. You will be surprised to see how much improvement one day or even 12 hours without leaking will do.

Let us know how she does.

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Tis may sound silly, but perhaps some time - an hour or two - without the bag and a chuck next to and underneath will let a little air and healing get to the irritated skin.

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Specializes in LTC/hospital, home health (VNA).
Tis may sound silly, but perhaps some time - an hour or two - without the bag and a chuck next to and underneath will let a little air and healing get to the irritated skin.

Hmm..good in theory. That could help some if...her stool/BMs are regular and not loose at all. Because if stool lays on her skin that could be just as irritating. If patient is able to keep it clean while it is off then maybe...but then you have to think who is able to stick around for 2 hours or more to rechange it.

Another thing I thought of..is if you cut the opening to the wafer way larger than the stoma - still use the powder and skin prep and maybe Duoderm. Then on the exposed peristomal skin you could use the powder, skin prep and then a thick barrier such as Calmoseptine..even mix a little stoma paste with the Calmoseptine so that any stool/drainage that gets on skin has quite a way to go to continue irritating the skin. That helped with a enterocutaneous fistula we were bagging.

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Specializes in tele, stepdown/PCU, med/surg.
I have seen good results with microguard powder then set with non-sting barrier then use a extra thin Duoderm over the irritated areas before using the stoma paste, stomahesive, skin prep, eakins, etc then the ostomy appliance. Hope you find something that works!

So you're saing to put the duoderm over the area where you just put the powder and non-sting barrier?

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Specializes in LTC/hospital, home health (VNA).
So you're saing to put the duoderm over the area where you just put the powder and non-sting barrier?

Yep. Protecting the skin with the powder and skin prep and let dry. Then use extra thin Duoderm over top -like a second skin to really let the peristomal skin heal/rest. You can then put the regular "stuff" (skin prep, paste, Eakins) you normally use to apply your ostomy appliance directly on the Duoderm rather than the skin.

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