Looking for stoma care info

prmenrs, RN · Nov 27, 2005

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

dawngloves, BSN, RN · Nov 27, 2005

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 · Nov 27, 2005

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.

dawngloves, BSN, RN · Nov 28, 2005

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

t2000JC · Dec 3, 2005

the hollister website really helped me out..t.

RNin2007 · Dec 7, 2005

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 · Dec 7, 2005

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 · Dec 7, 2005

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.

dawngloves, BSN, RN · Dec 8, 2005

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

RNin2007 · Dec 8, 2005

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

RNin2007 · Dec 8, 2005

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