need help ltc ileostomy

Up2nogood RN, RN · Feb 5, 2009

Rinsing the bag will help contribute to leaking. The size of the hole you cut sounds like it may be too big if the skin surrounding the stoma is raw? It's coming in contact w/ stool? Do you have a wound care consultant available to your facility or do you have a care manager? It's difficult to assess a stoma and what could be causiing these problems without seeing it firsthand.

SheriLynnRN · Feb 5, 2009

In my facility, we do not use skin prep under ostomy appliances because it contributes to leaking. Just a very thin layer of stoma powder if needed. Also, you want to cut the hole to fit the size of the stoma, no the size of the bag opening. I think the best thing for this pt would be a consult with a wound/ostomy nurse since she already has skin breakdown.

annaedRN, RN · Feb 5, 2009

Using an Eakins seal has been a huge help in many a leaking ileostomy in my experience. I usually use Microguard powder and non-sting skin prep x 2 to protect the skin. Occasionally a small amt of paste to fill in any trouble causing areas then Eakins. And as the above posters have said - be sure not to make the opening too large. Be sure you have the proper ostomy appliance as well - larger wafer size, more flexible, convex, etc

bebop1 · Feb 22, 2009

make sure you dust off any excess powder, the eakins seals are wonderful, or especially with the ileostomy I love using the moldable wafers. its from convatec, its great. it doesn't need any kind of past or anything the wafer itself is like the paste, you roll back the middle of the wafer, place it over the stoma, and when the moisture, or the liquid hits the wafer, it will swell and then turtle neck up a bit towards the stoma. and create a wonderful seal. the bag has to be vertical. this patient is in ltc right? is the patient going to go home? is the patient in rehab? the goal? the goal needs to be to empty the bag in the bathroom, if the patient wants a normal life again, and if the patient wants to "go out" and needs to empty the bag, where is she going to lay down to empty it?

I would focus the patient on her long term goals to let her see that the bag needs to be up and down, maybe change the kind of bag, make sure the excess powder is off, see what kind of diet she is on that can change the output she has and then her bag can not last long. you can place the wafter under her to make it warm, so when you finally apply it, it may stick better!

these are all little things ya can try...hope something works. but my last ileostomy patient that was changing hers 2-4 times a day switched to the moldable wafer now has hers on for usually a week at a time!!!!

Freedom42 · May 31, 2009

make sure you dust off any excess powder, the eakins seals are wonderful, or especially with the ileostomy I love using the moldable wafers. its from convatec, its great. it doesn't need any kind of past or anything the wafer itself is like the paste, you roll back the middle of the wafer, place it over the stoma, and when the moisture, or the liquid hits the wafer, it will swell and then turtle neck up a bit towards the stoma. and create a wonderful seal. the bag has to be vertical. this patient is in ltc right? is the patient going to go home? is the patient in rehab? the goal? the goal needs to be to empty the bag in the bathroom, if the patient wants a normal life again, and if the patient wants to "go out" and needs to empty the bag, where is she going to lay down to empty it?
I would focus the patient on her long term goals to let her see that the bag needs to be up and down, maybe change the kind of bag, make sure the excess powder is off, see what kind of diet she is on that can change the output she has and then her bag can not last long. you can place the wafter under her to make it warm, so when you finally apply it, it may stick better!
these are all little things ya can try...hope something works. but my last ileostomy patient that was changing hers 2-4 times a day switched to the moldable wafer now has hers on for usually a week at a time!!!!

Great thread. I'm a newbie and need help caring for two patients. One has an ileostomy; the other, a perforated esophagus with a large surgical wound covered by an ostomy appliance. I can't get straight answers from the nursing supervisors at my facility about how to work with these wounds and appliances. Each has a different approach.

First, the ileostomy: Right now, we're changing the entire appliance at least once a day. The wafer inevitably leaks and, because the patient is positioned on her side to offload pressure points, the liquid seeps through her sterile abdominal dressing whenever she's moved. The wafer is always difficult to remove, presumeably because the nurses don't use skin prep or adhesive dissolver. I've asked our secretary to stock this patient's room with these supplies. Are there other products or techniques that would make wafer removal easier? Then there's the issue of emptying the bag. I do it whenever I see that it's one third full and ask the aides to do the same (not exactly an endearing request). But others don't empty it during their shifts. How often should it be emptied? It seems to me that the more often we empty it, the fewer the chances that it will blow. When we empty it, should the bag be rinsed with a peri bottle and remaining matter wiped from the end with toilet tissue? (This is one supervisor's protocol; the other says no.) When cleaning the skin around the stoma, one supervisor insists that we use sterile saline. Is this necessary? And finally, I've seen references here to stoma paste and stoma powder, neither of which we use. What are the advantages of these products? Do I need an order for them?

Second, the neck ostomy: This patient is on the other side of our unit. Her appliance includes orders for skin prep and stoma adhesive (same as paste?). It's an awkward setup at best, since the top of the dressing comes right up under her chin and has to adhere to the curves. Where could I find information on techniques for proper removal and application? I'd like to do this right to minimize discomfort for this patient.

Thanks for any pointers. I've had no success yet in getting our wound care nurse to explain what the protocols are for these things. I'm inclined to think there aren't any, and since the nurses on our unit don't typically deal with them, questions that should be raised regarding orders are not.

ann c · May 21, 2011

hi worth trying the latest product from coloplast, really REALLY soft baseplate attached to bag (not yet available as bag that can empty) but if you're changing whole product each time it's ideal. VERY MALLIABLE. so suitable for really wrinkled, skin, or skin with curves due to position or surgical problems.

SENSURA MIO:

http://www.coloplast.co.uk/Products/ostomy/pages/productfamily.aspx?commcategory=SenSura_Mio(Coloplast)