TPN

•Determination criteria:

– Ostomy type

– Characteristics of effluent

– Topography of abdomen

– Peristomal skin’s condition

– Patient preference/fit

Before we discuss pouching options and accessories, let’s review what purposes the pouching system serves.

1.It contains effluent, gas & odor

2.It prevents leakage & can help to ease embarrassment

3.It serves to protect the peristomal skin, and

4.It assists the patient in their return to their previous lifestyle.

Criteria used for determining the appropriate pouching option for an individual includes:

1.The type of ostomy and the size, shape and location of the stoma

2.The characteristics of the effluent

3.The topography, size and contour of the abdomen (wrinkles and folds, incisions and/or scars)

4.The condition of the peristomal skin

5.The patient’s preference and individualized patient assessment factors regarding manual dexterity, vision, care environment, activity level, financial resources.

•Open end/Closed end

•One-Piece/Two-Piece

•Clear/Opaque

There are several pouching options available that can make the reality of living with an ostomy easier. Let’s take a look at a few of them.

All of the options we are going to talk about have to do with disposable ostomy bags. However, reusable bags are available. Only rarely are patients encountered who currently use or want to use reusable ostomy supplies, but they are out there. Should a patient be encountered that uses reusable products, it is best to consult with a wound and ostomy care nurse, or the product manufacturer, on the best options for care.

Disposable systems utilize a pouch (either clear or opaque) to collect the effluent with either a 1-piece pouch, or 2-piece pouch with skin barrier (or wafer), to protect the skin. It is usually recommended that new ostomy patients use a clear bag at first to help with bag changes. This slide shows an example of a 2-piece system on the left and a 1-piece on the right.

Skin barriers may be made from pectin, carboxymethylcellulose, karaya or an extended wear polymer. Beside the wafer, skin barriers are available in ring, powder and paste formulations. In the initial post-op period, a clear pouch is preferred to facilitate the required frequent stomal assessments, as well as the use of a cut-to-fit skin barrier to accommodate the changing stoma size as the post-op swelling decreases. It is usually easier for patients to center the skin barrier or wafer around the stoma when a 2-piece system is used, enabling the patient to change the pouch without disturbing the skin barrier.

•Cut to fit/precut

Pouches are also available with pre-cut skin barriers for ease of use, or for a more custom fit, cut-to-fit barriers. 1-piece pouches are available with either option, and for patients who like a 2-piece system, the same options apply.

Generally, patients with an uncomplicated stoma and peristomal surface may elect to use a pre-cut skin barrier or wafer. Whether the patient uses cut-to-fit or pre-cut, the size should be no more than 1/8” larger than the diameter of the stoma itself.

•Flat/Convex

In order to achieve the best seal possible, pouches and barriers come with flat or curved (called convex) skin barriers. This allows for the best possible surface seal that eliminates leakage. Several factors determine which type of barrier to use, but generally speaking patients who have flush or retracted stomas, or bellies with more fat, folds or scars will want a convex skin barrier, while flat bellies will work best with a flat barrier. Convexity also helps to pop the stoma up by depressing the peristomal skin, and improves wear-time by decreasing problems associated with effluent seeping out from under the skin barrier. An ostomy belt can also be worn to increase convexity and support.

This slide shows both types of barriers—as part of a 1-piece pouch, or just the skin barriers for use in a 2-piece system. For more pictures of the many options available, visit one of the ostomy supply company’s websites.