HELP! Ostomy bag will NOT stay on!

BittyBabyGrower, MSN, RN · Dec 28, 2010

I hate bags like that and sometimes there is NOTHING you can do but wait for re-anast and be vigilant in skin care. Make sure you are using plenty of skin prep/barrier around the stomas so that they don't erode.

I'm sure you've done this: make sure the wafers are warmed, put a warm pack on it after you apply it. We will sometimes wrap kerlex around the baby and the bag to try to keep it from pulling up, but they just don't have much skin space and they are wiggly.

Our stoma nurses consider it a challenge to come into our unit.

HappyBunnyNurse · Dec 30, 2010

I always go all around the edge of the wafer and onto the tummy with tegaderm (a lot of tegaderm). Most of the tummy may get covered sometimes depending on how small the baby is. It's ok though because you can still see the leaks because the tegaderm is clear. Also for a squirmy baby I get the next size diaper from what they really need. That way I can just put the bag inside the diaper and fasten around it. This is in addition to good skin prep (wash with soap and water, skin prep gel, and stoma powder) and making the hole(s) as small as possible. Also like bittybabygrower said heating those wafers is very helpful. I warm them between my hands but the heel warmer sounds like a great idea!

NeoNurseTX, RN · Dec 30, 2010

Are you sure we aren't taking care of the same kid? We had one with bag changes every touch time. It was a VERY trying experience. Then suddenly something would work and then another part of it wouldn't...then that would fix itself and something else would go wrong. THE WHOLE TIME the baby had stomas.

Eakins helped a lot, tegaderm does nothing, trust me. If you see it on the tegaderm, it's on the skin.

HappyBunnyNurse · Dec 30, 2010

You put the tegaderm on when you place the bag. It goes over the edge of the wafer and on to the skin. When the bag starts to leak you usually see the stool leaking around the wafer under the tegaderm. Never put the tegaderm under the wafer. And never use it reinforce one that is already leaking. The tegaderm is just there to reinforce. It is NOT skin protection.

NICU_babyRN, BSN, RN · Jan 3, 2011

It's always tough when you have double (or triple) stomas to cover!

Sometimes it helps to have the infant slightly sedated when changing the bag so that their tummy is relaxed and he/she doesn't fight you during the bag change. I'm sure you have a couple of helpers who can soothe the kid while you work on the bag.

Cut the smallest whole possible on your wafer and get that thing WARM! the warmer the better. While it's warming, clean the skin with soap and water and dry throughly. Use skin barrier and cover the entire area in which the wafer is going to adhere to.

If you have stoma adhesive cream DON'T over use it. It should be a thin "string" of it around the stoma only. smooth that down with the skin barrier too. this makes it even sticker. Now apply your bag and use a q-tip to get the stoma entirely into the other side of the wafer (inside the bag). You may get a little bleeding from the stoma but it's ok. I then place heel warmers over the bag for a while until I know it's REALLY on!

I can give more tips you PM me with the names of all the products you have available.

helicoptergal, BSN, RN · Jan 11, 2011

I had the occasion to work with a patient with a really challenging ostomy. The patient had a double barrel ostomy with the mucous fistula very close to the umbilical area. There was an area of skin break down between the primary stoma and the mucous fistula making the wafer almost impossible to seal. So the appliance was replaced multiple times a shift. I was able to have a Ostomy Nurse come and evaluate the ostomy and give me her guidance.

She said to cleanse the area with a warm wash cloth and either air dry, dab dry, or dry with 02 tubing. She said to apply the, stoma powder just enough to stick to the area and brush off any clumps. Then to apply the no sting barrier film. With this pt we used a Cohesive Wafer, it is much thicker than the standard wafer that is supplied in the bags. she said to get it to the consistency of "play dough" it will do this if you warm it in your hand or use a heel warmer. And then apply to the stoma and tuck the circle (that was pre cut with the template in the ostomy bag box) as close to the stoma as possible without causing circulation compromise. She then said to evaluate the stool type and if it is watery (my pts was watery) cut the bag on the bottom and put some cotton balls inside to "wick" the stool away from the stoma and use the twist ties provided in the ostomy bags for closure. I tried this and found the preemie bags (size 1570) when cut and twist tied shut leak, so I chose not to do this method when I needed to do the next appliance bag change. She also said it is okay to reinforce the sides of the wafer with duoderm if leakage is a risk. Hope this helps. I will always look for better ways to manage ostomies in our precious babies.

NeoPediRN · Jan 11, 2011

What is causing the bags to slip off - too much leaking from the stoma, or the awkward position of the double buds?

twinkletoes53 · Jan 11, 2011

You did get some excellent advice from previous replies. we call on our surgery specialty nurses as needed to advise us on stoma care in difficult cases. I always have a second nurse or PCT available to assist me with ostomy bag changes, especially complex ostomies (double stomas). We used a 2-part Hollister system in our unit. I cut the wafer to the designated template size, and pre-warmed it under a heel warmer. Gently wash the infant's stomach with Dial soap and rinse with warm water. Pat dry. Don't use Baby bath b/c it has oils in it. While I'm doing this, the second nurse is holding gauze over the ostomy to keep the output wicked and off the skin. I always have the baby's pacifier available, swaddle him if possible, except for his abdomen, medicate for pain if a med. is ordered, or use SweetEase if he meets the protocol.

I use the Skin barrier on baby's skin. Make sure it's tacky. If necessary, I will squirt some stomahesive paste into a 5-10 ml. syringe, and use that to control my hand so I squirt only a thin layer of paste around the edges of the ostomy. Once the bottom wafer is warmed, I apply it to the baby's skin. Continue to keep gauze over the ostomy, wicking up the output. I will use a second heel warmer or my hand to cover the wafer until it warms to the baby's skin temp. Because usually after you've done the above skin care, the heel warmer covering your wafer base has started to cool. Once the wafer is securely attached to the baby's skin, I placed the bag over it. We used preemie bags a lot, and kept them emptied often. Very important if you have a lot of output. If the baby was small enough, I would use a second diaper placed sideways over the baby's abdomen, back to front, to provide additional coverage. Sometimes I used a diaper one size larger than the baby to do this.

Good luck. Stoma care is a learned skill that needs a lot of patience and practice.

helicoptergal, BSN, RN · Jan 14, 2011

Hi, The leakage was related to both the positioning of the stoma and mucous fistula. Also the skin between the areas was uneven, so that made sealing it more challenging. Thankfully he is being reinastamosed.

PrudenceNurse · Jan 17, 2011

How about the "Eakin ring"? It is a moldable pectin-based substance. You can roll it (like playdough) into a "snake" and then mold it around and between the stomas to form a flatter surface that bags will stick to better. I've also tried using a "No-Sting Barrier" on the skin; its not an adhesive, but it makes the skin a bit tacky and things seem to stick better. It also of course is a skin protection, so it's win-win.

rockabye · Jan 18, 2011

To make the skin really sticky for the ostomy wafer, I apply benzoin on top of the no-sting skin prep. Make sure to wait a couple minutes to let those two dry so they will be extra sticky and also not let any poop get on the skin before applying the wafer. I don't like using paste on the skin because I don't get good stickiness with it and it gets messy fast. If the skin is uneven, I will use eakins. I will use both eakins and stoma paste around the stoma to help seal the base better since that's the usual culprit for bags coming off. I also pre-warm my wafer, eakins, and stoma paste before so it helps stick. Bag placement on the wafer is an important and sometimes missed opportunity. I always place the bag with gravity so that the drainage will flow and collect away from the stoma site. I also cut the hole on the wafer for the stoma a little on the smaller side and then stretch it a little so less skin around the stoma is exposed.