Stoma trouble

Posted
by Jaiden Jaiden (New) New

Specializes in NICU.

I'm new here but I was hoping someone might be able to help. I am newly qualified and work on a NICU (in London) which mainly deals with surgical neonates eg. NEC, Gastroschisis, Exomphalos, Oesophageal Atresia etc.

The neonate in question is a 32 weeker who is now 3 months old. He contracted NEC which failed to respond to medical management and he went to theatre for a laparotomy. He now has an ileostomy and a mucus fistula. Both stomas have herniated so are 'mushroomed' at the bottom and the fistula is badly prolapsed. His umbilicus is also herniated. This infant is about 3.5kg but has a very small abdomen as you would expect. We are having major problems applying the stoma bags as he needs one on both the ileostomy and the fistula. Due to the bad prolapse it is almost impossible to get a bag over the fistula (and it gets worse as he screams) and when you do the outside sticky part is barely adhered to the skin as it is too small. Child's mum has been applying duoderm around the edges of both bags and up over the ridge in between the bags to try and stop leaks. The bags are needing changing twice a day at least and the skin is starting to break down. We've tried putting 'doughnuts' around the base of the stoma but the main problem is getting the bags on. Any wise words?

Sorry if its all very ineloquent, I'm very new to stoma care as didn't get much experience of it as a student, and just want to find a way to make things better for this baby. Our stoma nurse is also stumped and the surgeons don't want to know!

Charlotte x

Sweeper933

Specializes in NICU. 409 Posts

Have you tried using stoma paste? It's used to fill in the gaps between the wafer and the bag. Works well when you have a tight area to work in and it's hard to get a good seal between the wafer and the bag all the way around.

In my unit, when the stoma's start prolapsing as bad as you have described, we to take them to surgery quicker than we otherwise would have, so they can be reanistamosed.

Jaiden

Jaiden

Specializes in NICU. 4 Posts

Hello, many thanks for your reply.

Sorry for being ignorant but what is the wafer?! Is this paste available in the UK do you know? I think I'll speak to the stoma nurse tomorrow about it or who knows since I've been away they might have refashioned it!

Charlotte x

Sweeper933

Specializes in NICU. 409 Posts

The wafer is the donut shaped piece of duoderm that gets cut out to go between the skin and the bag. It gives the bag something better than just skin to stick on to. It also helps protect the skin surrounding the ostomy. As far as the paste goes - I have no idea what you would have available over in the UK... The stoma nurse should know what it is if you do have something you can use.

Jaiden

Jaiden

Specializes in NICU. 4 Posts

Thanks ever so much, that's really helpful :wink2: I can see I'm going to find this place really useful :up:

Will let you know how we get on!

Charlotte x

NurseKerry

NurseKerry

Specializes in Labor and Delivery and NICU. Has 8 years experience. 15 Posts

Make sure the skin is very dry.

Put the stoma paste in a syringe and apply very thin rings of paste between stoma and any gaps in wafer.

Heat the wafer before you apply it. And place a hotpack on after the bag is fully applied, this will help the wafer adhere to the skin.

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