Please help pt with leaking colostomy

[ditchdoc]

Hi all I am at the end of my rope with one of my home health pts. He has a diverting colostomy due to a very nasty peri-anal wound (he has a wound vac in place). Any way the issue is not with the pts wound vac it is with his diverting colostomy. The darn thing no matter what I do, how hard I try, I am talking duoderm lite, wound vac drap, stomehessive paste you name it Iv'e tried it it always holds for 1/2 to a full day then after that it starts to leak in the same place everytime. The colostomy is on the pts left side and the leak always happens on the pts right hand side between the stome site and the pts naval. I am serious here folks I have tried everything and called everyone that I can think of her, I have in not so many words used up my list of people to call and used all of the tricks that I know to do. Please help I will take any advice that you can give me here. The pt is on blood thinners and his skin is so broken down now I have to put a piece of duoderm lite on a spot due to so many different appliances being put on and then off, between that and the stool eating his skin away it wont be long before he wont have any skin left to place a appliance there anymore. Thank you for any thing that you all can think of.

[annaedRN, RN]

sounds like you have tried most of the tricks. have you tried medical adhesive spray on top of the duoderm before applying the wafer. Using eakins rather than paste. how about some of the cement? making sure that each product you try/apply dried sufficiently so it doesn't work against you. I like to use antifungal powder then nonsting barrier wipes on broken down skin - apply it then let dry and apply it again - then the duoderm. have you looked into him eating foods that constipate for a day or two to "give it a rest"? hopefully you'll find the trick! good luck to you and him!

[tewdles, RN]

Along those same lines...try to get the stool under control. Typically a diverting colostomy does not have liquid stool output. The fact that he is leaking liquid stool suggests to me that something in his diet or medication profile (if not his disease process) is causing the problem.

poor guy! Good luck.

[beast master RN]

man ,i do wound care on the weekend , and it seem like every other time i go in this guys room his colostomy is blown , and when it blows it blows cracy style , and it sometime it just gets filled with gas to the point were theres no more room for anything, iv heard of getting a small needle and pricking a tiny whole so the gas leaks out idk, we taken it off to clean it and iv seen **** shoot 6 inches off his body out its ridiculous

[annaedRN, RN]

make sure his bag has a charcoal filter built in- that would help keep gas from building up. and, yes, like tewdles said - look into why a colostomy has primarily liquid stool - should definitely be more formed unless there is an underlying GI disease

[tewdles, RN]

Okay, so if gas is a big problem get him an appliance with a valve. Why not palliate the gas with something easy? Talk with the doc and see if that would be possible. Dependent upon the situation, things like Beano or GasEx can be useful.

You are correct that you have to change this system as frequently as it fails and work hard to preserve his skin integrity. Still, the focus really needs to be on the frequency and consistency of the stool, if you can. IMHO

[vinsonmm]

All the replies are good except I'm not sure what Beastmaster RN was talking about.

My only suggestion would be to try benzo tincture to make the area as sticky as possible AFTER you apply the skin prep.

[Melina]

Have you tried switching brands? Cymed makes an excellent product that uses a transparent film instead of a hydrocolloid wafer. I've used it with great success on several occasions.

[finchfamily4]

I vote for trying an Eakins Seal. As long as you get the base dry first. Try using skin prep then stoma powder then skin prep - Make the base feel like dry sandpaper - then Eakins. It's worth the $$

[smashms]

try eakins or adapt rings instead of the paste. i find that they work better