ileostomies and fistulas

[clever915]

i am sooo frusturated. i have a patient new in home health that has an ileostomy that does not stop leaking. i have tried everything stomaadhesive, adaptic rings, cleaning well with that 3m spray and barrier swabs. .....her ostomy leaks all the time. what is worse?? She also has a wound vac on her abdomen really close to the ostomy so when it leaks it goes straight into the wound and we have to change both 2 to 3 times a day. i dont know what i am doing wrong........i have tried coloplast strips.....any ideas??? some one help me???

[EJSRN, BSN, RN]

I've had this happen before, its such a pain. Have you tried like placing an extra drsg on the area that leaks? Like some gauze and an ABD pad and tape. Sounds like it may be difficult because of the location in relation to the wound vac. This wouldnt be a total fix, but it would aid in keeping it clean for longer. good luck..

[annaedRN, RN]

Sounds like you are prepping the skin/area correctly. It may be that she needs a different kind of wafer/appliance. One that is oval, or more flexible, or more convex...I have had a few ileostomies that make me want to go crazy, and after switching to a different (and better) brand/type- they are able to maintain a seal for quite a few days. Coloplast has a flexible, oval shaped wafer (with or without convexity) that seems to work well for alot of people. Let us know how it all works out.