HELP!! Ostomy problems

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I am a home health nurse and am having a lot of problems with a patient's ostomy. I have spoken with 2 physicians today (and the weekend girl spoke with one yesterday) and have also consulted 2 different wound care nurses with no luck.

Patient is an 80 year old male with hx of rectal ca. He had an ileostomy performed over 6 weeks ago. We have had an ongoing problem with leakage and some macerated skin under the flange from the beginning due to the shape and position of the stoma. However, he was doing well as long as the appliance was changed every other day. Then he got his latest round of chemo (5FU). So now in addition to the leakage problem, we are dealing with massive amounts of diarrhea and sloughing skin. The top layer of skin surrounding the stoma has peeled off and is extremely excoriated. He has a lot of pain anytime the area if touched. I was at his home for 2 hours this morning and had to change the appliance twice due to leakage. I have tried Tegaderm, duoderm, ostomy paste, powder, no sting skin barrier (cavilon), and mastisol. Nothing is working! It is not just a little leaking out either, it is large amounts. In fact, this afternoon I stopped to check on him and the bedpad under him was soaked with diarrhea that had leaked out. The longest he has gone with no leaks is approx 6-8 hours. We are starting him on Lomotil today so hopefully that will help.

Does anyone have any suggestions? The ostomy paste and other things are starting to burn now because of the excoriation. I wish he could go without the bag for a while and try to use some type of cream on the site (we use Greer's Goo at our hospital) but the diarrhea is just too much it would be a mess! Surgeon isn't planning to reverse him until the end of the month at the earliest. However, his oncologist told me this morning that he may have to hold off on his next round of chemo until after the reversal.

Please help!!!!!! Laura

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hey DaySleeper

I'm about as far from your line of nursing as it's possible to be, I guess--strictlly ICU.

But I was thinking about your poor gentleman's problem....

Here in the ICU, I'd try a 'Montgomery strap'. Kind of an abdominal binder but with laces like an antique corset (think 'Gone with the Wind' lace-up corset).

Cut a hole in the Montgomery Strap that matches up with the stoma, coat the Pt's tummy with your GOO, and find some way to put a pouch on the OUTSIDE of the Montgomey strap.

Good Luck. Let us know if anything helps/solves your problem.

Papaw John

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I'm thinking and asking around for ya!

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Hi, I'm Pamela. I'm a member of the UOAA. I'm an ostomate. Colonoscopy 1-4-07.

UNITED OSTOMY ASSOCIATIONS OF AMERICA

WWW.UOAA.ORG

1-800-829-0826

Following are exerpts from postings on this subject by Charles from TX. I have taken his advice and it has worked for me.

Clean the skin around the stoma and COMPLETELY DRY and if the skin is irritated or raw, apply Stomahesive Powder to the raw spots then spray with 3M Cavilon no sting Skin Prep. and dry again, then apply Turbot Skin Tac liquid adhesive http://www.torbot.com/view/179/69/ on both the skin around the stoma and the wafer and let it dry a couple of min. to become tacky, then place the wafer over the stoma and press it snug against the abdomen for at least another 2 min. to help it stick.

If you don't have the Skin Tac handy, proceed with the powder and the skin prep but warm the wafer a bit with a hair dryer to help it adhere to the skin. (not too hot, you're not wanting to brand your patient ;-) ) You can also use adapt paste or eakin seals to fill in dips or creases or uneven surfaces below the wafer. Then snap a 1" elastic belt into the loops on the pouch and adjust it to be snug, but not tight, to hold the appliance in place.

Cavilon no sting Skin Prep. Spray-28ml: 3M Corp. has just started marketing this same formula above as Nexcare No Sting Liquid Bandage and can be purchased over the counter at Wal-Mart Pharmacies and elsewhere for about $5.00

OSTOMY APPLIANCE MANUFACTURERShttp://www.ostomy.evansville.net/ostomymfg.htm

Maybe your patient would benefit by using a different type of appliance. EX: You may want to try a Moldable Convex Wafer by ConvaTec, it eliminates the need for paste or seals because it "turtle necks" to a snug seal around the stoma. Most all the manufacturers will send you free samples.

If you would like more advice or suggestions please contact the UOAA

UNITED OSTOMY ASSOCIATIONS OF AMERICA

WWW.UOAA.ORG

1-800-829-0826

Good luck

Pamela

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I might revert to a wound manager draining to a foley cath bag for times of ++diahrea..you can use a convex seal. I might try something like maalox to the excoriated peri-stoma skin. Just a thought.

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I had a similar problem a while ago with a patient.

Ended up doing the following:

Stoma powder on excoriated skin, then covered with Cavillon no-sting sealant.

Then put Adapt (from Hollister) ring around stoma.

Then used a Convatec Moldable convex wafer WITH A BELT. The belt seems to make the difference.

It was also challenging because the stoma was EXTREMELY active.

Good luck,

Oldiebutgoodie

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