jessieh13

Thank you all! Karen and ProBee I will have to look into those pouches and stabilizers...very good to know! BeenThere...I don't know what she meant by that. "Cotton kills" is something said by campers/hikers etc, because of how it can cause hypothermia when it's the only thing worn as clothing...not exactly a medical statement about dressings. There's no reason I can think of that cotton couldn't be used. Fortunately, this patient's nutritionist suddenly noticed that she has lactose intolerance, and has been getting tons of milk based products in her tube. They changed her feeding formula, and almost all of the leaking has stopped (I've been saying for a while that I will try to find a solution for the skin, but that really we need to be asking why she's leaking). Also, after discussion with people who are NOT the ostomy nurse the patient decided to begin refusing the mepilex foam, and demanding a silver alginate...her skin healed up within a week.

Hi all I work with home health, and this is in regards to a colleague's patient who has had a PEG for a LONG time (can't swallow d/t cancer and the treatments), and is having a lot of issues with the skin surrounding the PEG. There is an ostomy nurse at the nearby hospital that works with the patient and passes down orders, however they often don't make sense (I recently got my WCC training, but no ostomy training...) and the most recent set is at a new level of crazy. The issue is that this patient has a lot of oozing around the tube, usually made up of stomach contents (yeah, that's its own issue, we won't even go there). So the challenge has been to absorb all of that and protect the skin. From what I can tell they have been doing things like layer ostomy powder with aloe vesta etc which mostly just makes this abrasive paste, and then laying down a split gauze sponge. After the last visit to the ostomy nurse the pt was told "cotton kills" and the split sponges were d/c'd. The new orders are for 2-3x daily dsg changes on this thing, using mepilex foam (yep, the stuff that's like $7 each and supposed to stay on for 2-5 days) and antifungal powder. I've tried suggesting doing crusting, but I guess that suggestion was brushed off. I can't think what else could be put around the tube that would be absorbent and NOT a mepilex foam (which, unsurprisingly, isn't absorbing the drng well because it's basically stomach acid and tube feedings). Any ideas from ostomy nurses or nurses who work with PEG tubes a lot? The poor pt is constantly uncomfortable, and has high levels of anxiety anyway so this really isn't helping...