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Looking for stoma care info

We've suddenly had an influx of NEC kids,:uhoh21: , and a lot of us are out of practice with our stoma care. Any sites to help us out? Any parent info?

prmenrs, RN

Specializes in NICU, Infection Control.

What do you have for products? Does your hosp have access to an "ET"?

Here's one link, I'll try to find more.

http://www.preemiepouch.com/

Here's one for a journal article, maybe hosp library can get you the entire article:

http://www.jwocnonline.com/pt/re/jwocn/abstract.00152192-200303000-00011.htm;jsessionid=DKorrSaN5ZNs0JJBAc5TcnMDpYUyjgPEaDonzLOmohIp3FKQQuEN!-1660146838!-949856145!9001!-1

Here's something else:

http://www.emedicine.com/ped/topic2994.htm

We are pretty much on our own. Our Clin spec helps when she has a chance. We really need an inservice on affixing the pouches. If we aren't sure, how can we show the parents?

Gompers, BSN, RN

Specializes in NICU.

I can just give you the tips I give parents...

Do you use the Hollister brand bags? They have the Preemie Pouch and then a newborn sized one. We have to use the preemie one a lot, and it kind of sucks because there's no way to get the stool out without either taking off the bag or cutting it. We like it when a kid is big enough to use the newborn size, since it has a luer lock port to remove stool easily.

We only change the bags if they're leaking. Once the bag is off, we just use warm water and a washcloth to clean around the stoma, unless it's really dirty then we'll use Cetaphil or something gentle like that. After it dries, we'll put on the new wafer. We like to make a "sample" with a hole the size of the stoma, so we just have to trace it on the new wafer and then cut it out. Once cut, I rub my hands together to make them really warm, then press the wafer between them to soften it up. A heel warmer or warm blanket works even better. Once softened, it's so much easier to form it to the baby's skin and not have any pockets or leaks, and seems to last much longer.

My trick to getting the bag to stick on the wafer - Stoma-adhesive paste. I never put it on the baby's skin, of course. I take a 10cc syringe and pull the plunger out, then I put the tube of paste against it and fill it with the gook. Put the plunger back on, and now I've got 10cc of paste that I can push out through the tip of the syringe in a nice, thin line. I pull off the adhesive tabs for the bag and then draw a thin line of paste all the way around, since the adhesive on those bags is not very strong. Then I press it onto the wafer and hold for a minute or two until it sets. I've had very good luck preventing leaks (and therefore frequent bag changes) with this method, as well as warming the wafer first.

We don't see much skin breakdown around the stoma unless there are frequent bag changes, or if people are cutting the hole too big so it's exposing the skin around the stoma to stool. That's why we make that sample one - much easier to trace a wafer that will fit than to guess how big the hole needs to be.

Oooo! Thanks for that hint on warming the wafer first! That seems to be the big problem. Leaks.:uhoh3:

the hollister website really helped me out..t.

We just had a nurse specialist spend an afternoon training us on stoma care last Thursday. She brought in all the supplies, made a little red "femo clay" (you know...the type of modeling clay you can bake?...and she baked it) She took the false stoma and hot glued it to cardstock paper (index card would work)...then we all got to practice the whole process on our own. This would be good for the parents...and if they had a little false "practice stoma" it might help to lighten the mood a bit =). They looked simple enough to make...a little rosebud, bright red, with grooves maybe made with a butterknife?

Best of luck on this!

~J

Gompers, BSN, RN

Specializes in NICU.

We just had a nurse specialist spend an afternoon training us on stoma care last Thursday. She brought in all the supplies, made a little red "femo clay" (you know...the type of modeling clay you can bake?...and she baked it) She took the false stoma and hot glued it to cardstock paper (index card would work)...then we all got to practice the whole process on our own. This would be good for the parents...and if they had a little false "practice stoma" it might help to lighten the mood a bit =). They looked simple enough to make...a little rosebud, bright red, with grooves maybe made with a butterknife?

Best of luck on this!

~J

That's a really cool idea! We currently have a doll that we use for all kinds of parent teaching so they can do a little hands-on before dealing with the baby - dropping NGs, securing cannulas, GT and trach care, Broviac dressing changes, etc. When we have a baby going home with a stoma, we just "pretend" that the doll's umbiliculis is the stoma. Not as good as your cool clay models, though!

prmenrs, RN

Specializes in NICU, Infection Control.

We were able to get @ least a one-time consult w/a stoma therapist to get things started. She would recommend the products, make a "pattern", leave written instructions and sometimes return if we ran into problems. They are such a terrific resource--too bad they aren't better utilized.

Good idea! We should have an inservice. I'll talk to our clin spec.

The nurse specialist who came in and did our demonstration/presentation also told us she highly recommends using CURVED scissors...it makes cutting out the wafer much easier than straight scissors. Curved like these:

http://www.venusworldwide.com/images/embroidery%20scissors%2076%20copy.jpg

There are probably fancier scissors made specifically for stomas, but for parent's sake...the cost can be kept down by simply picking up an inexpensive pair like these at wal-mart or wherever they shop.

~J

As soon as I clicked submit to the last posting I remembered something else. The paste you use to create a watertight barrier on the babies skin...if you actually squeeze some out of the tube and let a little bit of the alcohol in there evaporate for 30 seconds or so in another container, you will create a better seal and therefore better protection for that tender preemie skin.

~J

I can just give you the tips I give parents...

Do you use the Hollister brand bags? They have the Preemie Pouch and then a newborn sized one. We have to use the preemie one a lot, and it kind of sucks because there's no way to get the stool out without either taking off the bag or cutting it. We like it when a kid is big enough to use the newborn size, since it has a luer lock port to remove stool easily.

We only change the bags if they're leaking. Once the bag is off, we just use warm water and a washcloth to clean around the stoma, unless it's really dirty then we'll use Cetaphil or something gentle like that. After it dries, we'll put on the new wafer. We like to make a "sample" with a hole the size of the stoma, so we just have to trace it on the new wafer and then cut it out. Once cut, I rub my hands together to make them really warm, then press the wafer between them to soften it up. A heel warmer or warm blanket works even better. Once softened, it's so much easier to form it to the baby's skin and not have any pockets or leaks, and seems to last much longer.

My trick to getting the bag to stick on the wafer - Stoma-adhesive paste. I never put it on the baby's skin, of course. I take a 10cc syringe and pull the plunger out, then I put the tube of paste against it and fill it with the gook. Put the plunger back on, and now I've got 10cc of paste that I can push out through the tip of the syringe in a nice, thin line. I pull off the adhesive tabs for the bag and then draw a thin line of paste all the way around, since the adhesive on those bags is not very strong. Then I press it onto the wafer and hold for a minute or two until it sets. I've had very good luck preventing leaks (and therefore frequent bag changes) with this method, as well as warming the wafer first.

We don't see much skin breakdown around the stoma unless there are frequent bag changes, or if people are cutting the hole too big so it's exposing the skin around the stoma to stool. That's why we make that sample one - much easier to trace a wafer that will fit than to guess how big the hole needs to be.

Is the wafer come together with the Hollister bags? Currently, I am nursing a baby with stoma but we just can't seem to prevent the stools from leaking from the side of the stoma bags. And now, the parents are quite upset with the excioration skin around the stoma(due to hte frquent changing of the bag). Can anyone help? :o

Gompers, BSN, RN

Specializes in NICU.

Is the wafer come together with the Hollister bags? Currently, I am nursing a baby with stoma but we just can't seem to prevent the stools from leaking from the side of the stoma bags. And now, the parents are quite upset with the excioration skin around the stoma(due to hte frquent changing of the bag). Can anyone help? :o

Yes the wafer comes with the bags, but it is separate and you stick the bag on the wafer once it's on the baby. Try the tips I gave about warming the wafer first so it forms to the skin better, and then getting stoma-adheisive past and putting it in a large syringe so you can squirt a line of it on top of the sticky part of the bag. It really helps seal the bag to the wafer well.

We use the stoma adhesive paste directly around the stoma, then a trick I learned is to takle a little bit of water on your finger and mold the paste so that it is completely surrounding the stoma. We really dont use the preemie pouches because they seem to come off easier. We really just use the peds bags...not sure of the brand...will have to look tonight. We dont have any problems with skin breakdown. However, when we have kids who have multiple stomas or who has dehisced (sp) it is is always harder to get something to work.

prmenrs, RN

Specializes in NICU, Infection Control.

There is a kind of bag that has a Tupperware-like seal so you can take it off and clean it out, look for undermining on the skin side.

There is another that has this clippie thing on the bottom--you unclip it and squeeze out the poop.

Problem w/both of these is that they're so narrow, it's hard to get them really clean. Go to the OR (or to Central Supply/Sterile Processing) and ask for a sponge clamp:http://www.wildcat.co.uk/acatalog/SPG.GIF. Then fold a damp 4x4 (or some other gauze square) and wipe it out.

elizabells, BSN, RN

Specializes in NICU.

Do any of you guys use benzoin? We had one baby whose bag we were changing, no lie, seven or eight times a shift. We had our WOC nurse come look, and the surgeons, but it was just the weirdest thing. We tried the wafer, we tried duoderm, we tried every adhesive known to man (including the special magic stuff our WOC nurse cooked up in a cauldron somewhere :lol2:) We finally discovered that her stoma actually opened right on the edge of her skin rather than on the top, so the stool was going under whatever wafer we put on her. Thanks, surgeon dudes! NOTHING we could do would keep the bag on her. Finally we tried benzoin, and it totally worked, but our girl screamed her head off every time we used it, so we stopped and just dealt. Thankfully she was reanastomosed before we all lost our minds (and before her skin broke down too much).

We use the Hollister bag with the little flip port at the bottom, and use a 10Fr feeding tube attached to a syringe to empty it. It's a little annoying, but it prevents spills, and it's really easy to measure output.

Gompers, BSN, RN

Specializes in NICU.

We use the Hollister bag with the little flip port at the bottom, and use a 10Fr feeding tube attached to a syringe to empty it. It's a little annoying, but it prevents spills, and it's really easy to measure output.

We just use a large luer-lock syringe attached to that port, no feeding tube. Do you actually stick the feeding tube into the bag? I've never heard of this, so I'm curious.

elizabells, BSN, RN

Specializes in NICU.

We just use a large luer-lock syringe attached to that port, no feeding tube. Do you actually stick the feeding tube into the bag? I've never heard of this, so I'm curious.

I'm not sure if the bag we used took a luer-lock... that's just how I was taught to do it. The baby in question had very liquid stool (like, totally liquid) so this may have been the easiest way. We did indeed stick the feeding tube into the bag, and sort of moved it around like you would if you were suctioning it. It was annoying, but the baby was so fussy it was the easiest way to do it without moving her too much.

I have used benzoin twice and found it to work exceptionaly well. However, the kids I used it on did not have any broken down skin so maybe the benzoin was burning.

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