Rough couple of nights and a question about iliostomys

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Specializes in Corrections, Cardiac, Hospice.

First off, my vent.

Yesterday I had 5 patients and and aide. They cancelled the other RN, which is fine, right? Well, normally it wouldn't be an issue, however: Of the 5 patients, 3 were dying. One was an admission with ES Alzheimers, very confused and VERY combative. One of the 3 that was dying had an iliostomy that leaked almost constantly. The bag had been changed on days and I had to reinforce it twice before changing it again. That includes 2 complete bed changes. Added to this, his daughter had a hx of paranoid schizo. and was NOT coping. I wanted to crawl home.

Ok, now my question: How do you stop and ostomy that is leaking? My heart was breaking for this poor guy. His skin was red and irritated and the stoma was actually bleeding he was rubbed so raw. I used a skin prep, and a glue stuff:lol2: (old cardiac nurse here) then something called and Ekcert seal. NOTHING worked. Any advice for next time?

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Specializes in ER, ICU, Infusion, peds, informatics.
first off, my vent.

yesterday i had 5 patients and and aide. they cancelled the other rn, which is fine, right? well, normally it wouldn't be an issue, however: of the 5 patients, 3 were dying. one was an admission with es alzheimers, very confused and very combative. one of the 3 that was dying had an iliostomy that leaked almost constantly. the bag had been changed on days and i had to reinforce it twice before changing it again. that includes 2 complete bed changes. added to this, his daughter had a hx of paranoid schizo. and was not coping. i wanted to crawl home.

ok, now my question: how do you stop and ostomy that is leaking? my heart was breaking for this poor guy. his skin was red and irritated and the stoma was actually bleeding he was rubbed so raw. i used a skin prep, and a glue stuff:lol2: (old cardiac nurse here) then something called and ekcert seal. nothing worked. any advice for next time?

i've had some luck with using duoderm/comfeel around the site.

[color=#483d8b]othe than that, just making sure the skin prep is "no-sting."

[color=#483d8b]really, i guess it depends on why the ostomy is leaking? a leaking ileostomy is always going to be the worst, because of all of those digestive enzymes. the earlier it is caught, the better. the longer it goes on, the more irritation developes, the worse the situation is.

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Specializes in ER Nurse, Level I Trauma, Home Health, VA PACT RN.

I used to be a homecare nurse and have had my share of leaky ostomies with limited supplies at the homes so hopefully my tips can help. After removing the old ostomy dressing and cleaning off any remaining stool or adhesive from the skin, make sure the skin is as dry as possible. I found that gently blotting the area with paper towels worked great. Then, apply your skin prep- yes, non-sting is best but use whatever you can get because using skin prep is one step that must always be followed to get an adequate hold in my opinion. After applying your wafer, use the warmth of your hand to press it against the skin for several seconds to facilitate the bonding. Once your dressing is applied and seems secure, take Tegaderm (or something similar such as wound vac transparent dressings; they work great when cut in strips) and apply it in a window pane fashion around the wafer. I've done this for years and it works very well- especially if you overlap the Tegaderm at least 1/2 inch or more over the wafer. I hope this helps.

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Home nurse is much better!

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I just took care of a pt like this. He also had a wound vac dressing a few inches away from the ostomy. Yuck. Yuck. (To be honest, I think he was picking at the dressing too) I swear, we changed it 3 times a shift.

What I did....clean and pat dry. Non sting skin prep. cut the wafer as close as I could. Stoma paste around it where the skin was intact. Apply wafer then I would put zinc oxide around the stoma to protect that little bit of skin. I would also try to reinforce the wafer with a duoderm or transparent dressing like HomeNurse described. When all of this was done, I would put towels/ chucks under the ostomy side just in case..and so that the bed would need its 20th change of the day. :trout:

As a PP stated...try to look at why it was leaking so much. Is it the seal is bad becaus the skin is so bad because of prior leaks? Is it because the stoma is in a bad place like an abd fold so that every time they move the seal comes off? Is the patient picking at it? Do you have an other wound close by?

Unfortunatly I had all of these conditions with this pt. Add him to about 24 other LTC/ sub acutish pts.....I wanted to drink!

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Specializes in Home Health, PDN, LTC, subacute.

Had a patient in LTC with this. She leaked no matter what we did. Reinforce around the edges with Tegaderm, cut it into strips. I used to check her q. 2 hours. Also, with some bags you can hook them to a Foley. THis helps if it runs constantly.

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We had a pt w/the same issue. There are appliances that actually have a cone that fits into the stoma as well as around. This helped some, however we were never able to stop the leakage. Maalox applied to the skin around the appliance (not under) helped with the irritation by neutralizing the gastric acid and using peripads on top of the maalox absorbed the fluid before leaking any further than possible. Unfortunately, she passed away before we were successful in solving the problem. I hope you have better luck.

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Specializes in Corrections, Cardiac, Hospice.

Thank you all so much! I will keep all these hints in mind. I work at an inpatient hospice, so my goal is comfort, not healing. I really like the Maalox hint and the great duoderm/tegaderm ideas.

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Specializes in ortho/neuro/general surgery.

Don't have my own advice to add, but wanted to subscribe to this thread and thank all the previous posters for sharing their techniques.

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Had a patient in LTC with this. She leaked no matter what we did. Reinforce around the edges with Tegaderm, cut it into strips. I used to check her q. 2 hours. Also, with some bags you can hook them to a Foley. THis helps if it runs constantly.

I agree, they key is to keep the skin as dry as possible, placing a bag that continuously drains works very well. I also find using stoma heasive around the stoma itself and tegaderm to seal the outside wafer works.

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Specializes in Travel Nursing, ICU, tele, etc.

Honest to God, I once admitted a patient who had used duct tape to secure his leaky ileostomy! He claimed it was the only thing that worked!! Not that I'm recommending that! hehe

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Specializes in LTC, med-surg.

Hi everybody,

sorry to hear about the rough night. Regarding the leaky ostomy: Once it is leaking it should never be "reinforced". The entire appliance should be removed. Cleaning and drying the skin is essential, also try putting the ostomy paste on the wafer (sticky side), about 0.5 cm in, wait one minute---check to see if paste makes strings (like really sticky hairgel that's drying). Then put on wafer. Apply stoma paste around stoma (all the way). I find this really helps with leaky ostomies.

Diana

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