TPN

Ostomy Accessories

•Skin barrier wipes, adhesive remover wipes,

stoma paste, stoma powder

•Skin barrier pastes, powders, rings & strips, tape

Skin sealants or skin protectants are applied to intact peristomal skin prior to the application of the skin barrier. They protect the skin from effluent and keep the skin from stripping when the adhesive barrier or tape is removed. These same products are used to protect periwound skin when adhesive dressings and tapes are used.

The various skin barriers help to protect the peristomal skin and create a level pouching surface when the abdominal topography is uneven. A thin bead of stoma paste can be used around the skin barrier/faceplate opening, sized to the individual stoma. The patient should then be instructed to wait about a minute, then apply to the abdomen.
This works like caulking to form a seal. The paste can enhance weartime by preventing effluent from undermining the pouch’s seal.

Tape may be used for waterproofing and to provide additional support to the faceplate or wafer. Patients should be instructed to apply skin sealant to affected areas before any tape is applied.

Pouch Filters, Deodorants

Ostomy Belt

Overnight Drainage Bag

Pouch filters and deodorants: when appropriate choices are made with regard to product selection, product application and patient teaching, odor should only be found when emptying or changing the pouch. This means that with the appropriate products and proper technique, odor should not be an issue affecting everyday wearability. Most pouching systems now are odor-resistant,[2] and there are are liquid deodorizers on the market, like Banish, that can be placed in the pouch. Some patients may try deodorizers by mouth. Bismuth subgallate (known as Devrom), activated charcoal (Charco Caps) and chlorophyllin (Derifil) are some examples. Patients are taught to cuff the bottom of their drainable pouches when emptying them and to avoid odor-producing foods such as onions, garlic and cabbage. Patients should also be instructed to be alert for a strong urine smell, as it has a much stronger odor in the presence of infection.

Aesthetic pouch covers may be used during intimacy, and also if the plastic of the standard pouch is uncomfortable against the skin, or if the pouch just feels too warm.

All patients with incontinent urinary diversions should be taught how to use a nighttime drainage system to prevent premature, accidental removal of the full pouch. These nighttime systems consist of a large rigid container, an extra length of tubing, and an adapter to connect the tubing to the bottom port of the pouch. An included leg strap can be used to keep the tubing from getting twisted or pulled.

Factors Affecting Wear Time

•Stoma characteristics

•Stoma output: amount/type

•Abdominal topography

Condition of peristomal skin

Type of skin barrier

Patient preference

Wear time is defined as the predicted amount of time between pouch application and pouch removal.[2]

A study described in the September/October 2008 Journal of the Wound Ostomy and Continence[3] found in a national survey that the mean wear time in the US was 4.8 days. For urostomies the mean wear time was 5.02 days, ileostomies 5.01 days and colostomies 4.55 days. The authors stated that further research is needed to establish benchmarks for wear time and to identify the factors that affect wear time.

Some factors reported in the literature that influence wear time are the characteristics of the stoma including its output, as well as the surface of the surrounding skin, and whether it is smooth, firm or soft. Also important are the type of skin barrier used and, of course, patient preference.

1. Fecal & urinary diversions: management principles.
Colwell J, Goldberg M, Carmel J.
Publisher: St. Louis, Mo. : Mosby, c2004.
ISBN: 0323022480 LCC: RD540.6

2. Br J Nurs. 2008 Sep 25-Oct 8;17(17):S12, S14, S16 passim. Colostomies and the use of colostomy appliances. Cronin E.

3. J Wound Ostomy Continence Nurs. 2008 Sep-Oct;35(5):504-8. Ostomy pouch wear time in the United States. Richbourg L, Fellows J, Arroyave WD.