Leaking Ileostomy - any ideas?

[lovesmarissa]

Hello there,

Anyone here have any ideas on what else can be done for this patient? He has an ileostomy that is leaking constantly. His skin is so irritated right now, and he also has an old incision scar that is about a half inch wide that the corner of the wafer unfortunately has to go over - he doesn't have a nice smooth surface of skin for the wafer to cling to - so his ileostomy leaks after a couple of hours, no matter how often we empty the pouch or stool or gas, etc...he is currently using skin prep, stomahesive to apply the wafer. I'd appreciate any advice and suggestions on this one - the doc we have read somewhere that heating up the wafer can soften it up, thus allowing it to have a better seal with the skin, but that is not working either. You know how if a wall has a hole and you can spackle over it to make it smooth? I wish there was something like that for him, just so he can have some relief! And maybe some nice uninterrupted sleep too....

Oh....forgot to say, the ostomy nurse from one of the hospitals came to check things out and unfortunately did an even worse job changing the wafer and bag than we've been

Thanks :)

[alli]

Where I used to work we had this round putty like ring we used with the wafer, called an eakon sp? How it works is that you can put it around the stoma to kind of even it out then you put on the wafer. The eakon actually works pretty well. Just check to see if your hospital carries it or ask the ostomy nurse to make a special order if possible. Hope this helps.

[pengpeng10]

first of all, if the patient's skin is excoriated around his stoma, the wafer just won't hold. you need to get some no sting barrier spray (we use 3m brand). sprinkle the skin around the stoma with desenex powder, wipe the excess powder off, and then spray with the no-sting spray. this will set the powder. then you put your wafer on as usual using the stomahesive paste. a question: is the stoma flat against the skin or does it stick up? if it is flat you may want to try a convex wafer. another thing is to place an ostomy belt on the patient. you'll find that after a few treatments with the desenex and spray the excoriation will greatly improve.

[Bubonic Betty]

Skin should be cleaned without any oily or moisturing soaps. Ivory works well. I've never heard of using Desenex for ostomies; it's a foot spray no?

Anyhow, using skin prep, cover the excoriated skin with it, then add Stomahesive powder. gently wipe off excess powder and add more skin prep. You may make several layers of powder and skin prep ending with the skin prep so it is sticky.

I too would also suggest a convex wafer. It will press down uneven skin for a better fit. Stoma paste can be used but do not put it directly on the patient's skin. Put it around the opening of the wafer- not too thick or it will cause the wafer to pop off. The paste must sit on the wafer for at least a minute before application. Skin prep can also be used over the entire area where the wafer will adhere. The trick is not letting it dry completely or it won't be sticky enough. If it is too wet, it won't be sticky enough.

Now, to get it to stay on well:

After centering around the stoma and putting it on, gently press down on the area all around the stoma- right next to it. Be careful not to press on the stoma itself or with your fingernails. Go all around like this several times. Do this all over the wafer. Also, using a hair dryer on warm setting while pressing around will help it to stick. Have the patient keep the palm of his hand over the ostomy gently pressing for several minutes after application. Alternate with the hairdryer for warmth. The warmth will help it to stick and conform to the body.

Last but not least; is the wafer opening the correct size? If it is too small it will leak. If the stoma is irregular you may need "cut to fit" stoma opening to make the precise shape. You cannot "cut to fit" convex wafers though.

I have heard of Eakon seals. It's like gum and can be shaped to fit. I had no luck with it personally but some patients like it.

[WV_heart_RN]

Hollister has what are called ' adapt barrier rings' They are flat or convex. Please do not use convex rings if the patient does not need them. Especially if this is a new surgery.

Anyway, These rings are waxy and can be placed around the stoma to give you a flat working surface. They do work well. You may have to soften them before applying. There is also Adapt paste that can be used to fill in an uneven area. I have one patient whose incision went through her naval and the stoma was pulled through right above the naval. This caused her to leak all the time. We filled in her naval with the paste, let it harden until it was no sticky and BINGO! SHe has not leaked since then.

LEt us know how it goes!