Ostomy care question

[AmericanChai]

So I'm in Block 1 nursing school, just starting out. :-) Today we learned about ostomy care. I was just wondering how it's possible for someone to have an adhesive on their skin for months or years without skin breakdown??? If it does get skin breakdown and need to be aired out to allow it to heal, how is that done without fecal matter getting on the skin and further irritating the skin condition?

[Fiona59]

Patients are educated in skin care. There are barrier creams, ointments, wipes on the market.

When we've seen skin breakdown near a stoma it's been due to poor fitting of the appliance or a change in their overall health.

[annaedRN, RN]

Yep - what Fiona said. Cleaning and prepping the skin with each change is the key. It is sometimes trial and error to get the correct wafer/appliance initally but once it's found it usually goes smoothly. Also, if it is a colostomy, especially located at descending aspect of colon - the bowel movements are regular...a person will often be able to remove their wafer, take a shower and let the area open to air and have plenty of time before they need to reapply everything..not so much if it is an ileostomy.

[tewdles, RN]

yup, what they said.

Most healthy persons with stomas do pretty well with only the occasional short term problem. There are good products available and education is key.

[tewdles, RN]

Ileostomies are somewhat more prone to irritation than colostomies...nature of the stool.

[AmericanChai]

Thanks for letting me know! I'm glad that these patients have so many options.

[lopet19]

i work in a nursing home and i take care of two patients with ostomy bags. You have to make sure the site is cleaned at all times , also it is put on correctly and fits correctly. I change it q24h during am care and the rest of the shift monitor the site and burp the bag. However during cleaning you are bringing blood to the surface which is promoting circulation. I like to clean with a wash cloth with ivory soap nothing with fragrants. Also when the are is cleaned i use a prep which helps the adhesive stick better also try rubing the wafer between your hands to warm it older nurses taught me that it really does help with it sticking to the surface better i hope that helped.

[Indy, LPN, LVN]

Ok, I will have to try warming the wafer with my hands, that sounds like it would work well. I agree 100% with the thorough cleaning and use of skin prep. I use paste depending on the situation, about half the time.

[tewdles, RN]

why are you changing the ostomy appliance Q24 hr?

[Fiona59]

An appliance can last up to one week if properly fit and attached. The frequent changes are usually what brings on a skin irritation due to the adhesive going on/off.

[SunnyAndrsn]

Agreed.

My husband uses an insulin pump, the site is changed q3 days, and even for that we use Skin Prep. We use skin prep on boggy heels/red heels to help provide a small layer of protection. We apply it BID as a nursing order. Our wound care protocols also use skin prep on the skin surrounding moist wound environments, especially those that use hydrofera blue, wet-to-dry dressings, aquacell, or xeroform/petroleum gauze. Anything that, if left around the healthy skin could cause maceration.

Come to think of it, even when we use duoderm, we apply skin prep around the area too for adhesion.

An appliance can last up to one week if properly fit and attached. The frequent changes are usually what brings on a skin irritation due to the adhesive going on/off.