CLINICAL UPDATE
Stoma complications: an overview Jennie Burch
Jennie Burch is Enhanced Recovery Nurse Facilitator, St Mark’s Hospital, Harrow, Middlesex
T
© 2013 MA Healthcare Ltd
here are about 102 000 people with a stoma in the UK (Black, 2009).There are three main types of stoma that the community nurse may encounter: colostomy, ileostomy and urostomy (Burch, 2008). The community nurse is not expected to be an expert on stomas and can contact the stoma specialist nurse in the local hospital for assistance with issues that do not resolve. However, it is possible that some common complications may be resolved without specialist stoma nurse input. This article aims to provide up-to-date information to assist the community nurse in caring for this patient group. If stoma accessories are appropriately applied, the community nurse may be able to reduce the overall prescription cost of products used. The colostomy is the most common type of stoma and is formed from the colon, usually to treat rectal cancer.The most common position for a colostomy is the left iliac fossa, between the navel and the hip bone. A colostomy is usually red or pink, is minimally raised above the skin by a few millimetres and is warm and moist to the touch. The output from a colostomy is formed faeces and flatus collected and contained in a closed stoma appliance. An ileostomy is formed from the ileum, often in order to treat people with inflammatory bowel diseases such as ulcerative colitis. The most common position for an ileostomy is the right iliac fossa. An ileostomy appears as a small spouted stoma (Cronin, 2013) of about 25 mm, and the output is loose faeces and flatus collected and contained in a drainable stoma appliance. An ileostomy appliance is generally replaced on a daily or alternate-daily basis and is emptied four to six times daily. A urostomy or ileal conduit is formed from the ileum and can be surgically formed to treat bladder cancer, for example. When the bladder is removed, the ureters attaching the kidneys to the bladder are cut away from the bladder and stitched onto a small segment of ileum. One end of the ileum is attached to the skin as the urostomy and the other end is oversewn to prevent urine from leaking into the abdomen. The urostomy has the same appearance and is in the same position as an ileostomy, but will pass urine and a small amount of mucus into a drainable bag with a bung or tap fastening. The urostomy appliance is generally replaced on a daily or alternate-daily basis and is emptied four to six times daily.
Stoma complications Complications can occur for a person with a stoma (ostomate) and it is likely that most ostomates will experience one or more problems with their stoma at some time. Some common complications may be resolved without specialist stoma nurse input. These include sore peristomal skin, constipation, diarrhoea and urinary infections. The following sections discuss possible
British Journal of Community Nursing Vol 18, No 8
Email: [email protected] complications and good practice that may actually help to alleviate the overall costs associated with such treatments.
Stoma accessories Martins et al (2012) argue there are high costs associated with peristomal skin problems that can be reduced with the appropriate use of stoma accessories. Herlufsen et al (2006) report that almost half of all ostomates use an accessory to enable them to have a secure stoma appliance. Notter and Chalmers (2012) suggest that half of people with a colostomy no longer receive specialist follow-up. Thus, the patient is likely to contact the community nurse for assistance if a complication occurs with their stoma. Although Persson et al (2009) consider that appropriate follow-up and treatment can prevent problems, there is no standardised follow-up procedure with the stoma specialist nurse for ostomates in the UK. ‘Enhanced recovery’ is a term used to describe evidencebased care of patients in the period before, during and after their surgery (Burch, 2013). This care pathway was initially used for patients undergoing colonic bowel surgery, but it is also now used for patients undergoing stoma-forming surgery and other operations such as orthopaedic and gynaecological surgery. Enhanced recovery aims to reduce the stresses of surgery and results in patients having fewer complications and a shorter length of hospital stay. The aims of enhanced recovery are to increase fitness before the operation and to resume daily activities such as eating, drinking and mobilising much sooner than was previously thought possible. Intravenous fluids and urinary catheters are removed soon after surgery—often on the day after the operation—resulting in fewer infections such as urinary infections. It is common for patients to leave hospital just 4 or 5 days after major surgery and in a better physical condition than with traditional care (Fearon et al, 2005). This may represent a significant improvement in terms of both patient outcomes and overall cost.
Sore peristomal skin Community nurses are generally very experienced at caring for wounds, but some wound care treatments are unsuitable for use with a stoma appliance. The usual wound care procedures should still apply, i.e. assessing the problem, planning and implementing a treatment and then evaluating its effectiveness. Peristomal skin should have the appearance of the rest of the abdominal skin and should be healthy and intact. Sore peristomal skin was reported by three quarters of ostomates in one study (Smith et al, 2002).This is a significant potential complication that requires efficient and effective treatment. A variety of severities can be experienced when the sore peristomal skin is assessed. Skin may simply be red (erythema),
375
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 22, 2015. For personal use only. No other uses without permission. . All rights re
CLINICAL UPDATE
376
Constipation A person with a colostomy is at risk of constipation in the same way as someone who has not had stoma-forming surgery. It should be noted that constipation cannot occur with an ileostomy. Ideally, constipation would be prevented, but if it does occur, there are a number of potential treatment options. Oral laxatives can be taken in the same way as a person without a stoma. It is also possible to use a suppository, but with some minor changes to insertion techniques. When a suppository is inserted into a colostomy it is liable to fall out of the stoma. Thus, the suppository needs to be held in situ for about 15 minutes. The stoma should initially be gently digitated with a gloved finger, then a suppository should be gently inserted into the colostomy and pushed as far inside as possible. The appliance should then be adhered quickly. Guide the colostomate’s fingers over the appliance and over the entrance of the colostomy and ask them to hold this position for about 15 minutes to allow time for the suppository to dissolve.
Diarrhoea A colostomate can have an infection and thus may develop diarrhoea. This should be treated after a stool test, using the appropriate antibiotics. Chemotherapy can also cause diarrhoea for people with a colostomy. While the diarrhoea persists, it can be advantageous to use a drainable stoma appliance to collect the loose faeces and to prevent the peristomal skin from being stripped and damaged by frequent appliance changes. Good hand hygiene needs to be explained to the ostomate to prevent re-infection of the patient themselves or those close to them. An ileostomate will usually pass porridge-like stool which can become thicker and looser depending on what the person eats and drinks throughout the day, with an average output volume of 600–800 ml daily (Black, 2000). It is possible that an ileostomate will become dehydrated if they do not pay attention to their dietary intake, and this can result in an electrolyte imbalance. People with an ileostomy therefore absorb sodium less effectively and can become sodium depleted if they do not take a little extra salt each day once they have an ileostomy (Smith and Boland, 2013). It is essential to consume adequate fluids to make up for the extra fluid lost in the loose stool: about 2000 ml daily is adequate for most ileostomates (Chandler, 2013a), and volumes of fluids consumed should not be dramatically higher than 2 litres. Consumption of carbohydrates with a reduction in the volume of fruit and vegetables will help to thicken the output from the ileostomy. Medication such as loperamide (possibly with codeine phosphate in addition) can also be used. In cases when the stomal output is consistently above 1000 ml daily, rehydration solutions can be useful.
Prolapsed stoma A stomal prolapse can be described as a protruding stoma that can be 10 cm or more in length. It is more common with a transverse colostomy, causing a dragging sensation. The risk of the stoma being damaged due to the bowel being outside the body is a significant one, and this may result in ulceration, bleeding and necrosis in extreme cases
© 2013 MA Healthcare Ltd
it may be broken and wet, or there may be erosion. The cause of the sore skin can also help to determine the treatment used. For erythema, the cause might be the stomal output touching the skin and causing damage.This can even progress to erosion in severe cases. The cause of the sore skin might be determined by looking at the appliance as it is removed to see whether there is anything visible to indicate a leak under the appliance flange (the adhesive part of the stoma appliance). Leaks might be due to a skin crease near the stoma, for example. Another cause of sore peristomal skin can be that the aperture in the flange is too large. This can occur when the postoperative stoma oedema resolves but the ostomate (person with a stoma) still cuts the hole to the same size. The postoperative stoma oedema can resolve for about 8 weeks following the stoma formation; in some cases there might be little alteration in the size of the stoma, but some can dramatically reduce in size.When observing the appliance and the stoma, the sore skin will often present as a halo of erythema around the stoma.This can worsen if left untreated, but, if caught early, the ostomate might simply report itching around their stoma as a result of the stomal output touching the skin and causing an irritation. In this situation it might be possible to treat by resizing the aperture in the flange. The flange is made of hydrocolloid and thus has healing properties that can heal sore peristomal skin without any other stoma accessory being utilised—clearly an efficient and effective treatment. If the cause of the sore skin is due to a skin dip or crease, this needs to be resolved by using a stoma accessory to level out the dip or crease. Accessories such as stoma adhesive paste or seals (also known as washers) may also be used in this situation. For erythema, the skin might simply require protecting by using a barrier film (Rudoni, 2011) to coat and protect the skin from the faecal or urinary output, or to protect from skin stripping. A protective film comes in the form of a wipe, spray or wand and there are a variety of manufacturers of this type of product. Some protective films contain alcohol and should therefore be used with caution if the skin is actually broken, as this will sting the ostomate. If the cause of the sore peristomal skin is due to skin cells being stripped when the appliance is removed, one treatment might be to retrain the ostomate to remove the appliance more gently, or to use an adhesive remover when the appliance is removed. The adhesive remover will prevent discomfort associated with appliance removal. If the peristomal skin is broken, effective treatment might be to use a small amount of stoma powder. The powder is especially formulated to absorb fluid from the oozing skin, to protect the skin and to allow the stoma appliance to adhere to the damp skin (Boyles, 2010). Caution should be exercised to ensure that too much powder is not used as this can result in the powder clogging up under the appliance, causing a leak. Another potential treatment choice for broken oozing skin is the use of a cool hairdryer. This is a treatment that is readily available to ostomates, but should be used with care as a hot hairdryer can burn the peristomal skin.When using a hairdryer it is important to keep it moving and to keep it away from the body to prevent inadvertent damage to the peristomal skin.
British Journal of Community Nursing Vol 18, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 22, 2015. For personal use only. No other uses without permission. . All rights re
CLINICAL UPDATE (Chandler, 2013b). The ostomate should be instructed to observe the mucosa of the stoma to ensure that it is not being damaged and to take care not to damage it during daily activities. Although surgery can be undertaken, conservative treatment is often advocated. It might be necessary to use a larger capacity stoma appliance to ensure that the bowel and effluent are contained (Dukes, 2010).
Urinary infection If a urostomate has a urine infection, this may be evident by an odour, increased mucus and cloudy urine. It should be noted that a urine sample should not be taken from the urostomy appliance but instead by gently catheterising the urostomy. Antibiotics can then be used to treat the infection.To prevent a urine infection the urostomate should be encouraged to drink 2000 ml of fluids daily. Cranberry juice may help to prevent infections if consumed daily, and can be an effective and efficient treatment.
Conclusion It can be seen that there are a variety of problems associated with stomas. The community nurse can assist ostomates with some simple techniques or advice. Sore skin needs to be carefully assessed to ensure that the cause is addressed and treated. Treatment may be as simple as checking the size of the aperture in the stoma appliance and resizing it. Importantly, by using stoma accessories appropriately, the community nurse may be able not only to resolve problems associated with the stoma, but also to reduce the cost of stoma products used in order to
achieve a secure appliance seal. Other issues such as diarrhoea, constipation and a urine infection can also often be treated in a similar way to people without a stoma. BJCN Black P (2000) Holistic Stoma Care. Balliere Tindall, London Black P (2009) Managing physical postoperative stoma complications. Br J Nurs 18(17): S4–S10 Boyles A (2010) Stoma and peristomal complications: Predisposing factors and management. Gastroint Nurs 8(7): 26–36 Burch J (2008) Stomas: the past, present and future. In: Burch J, ed. Stoma Care. Blackwell Wiley, West Sussex. Burch J (2013) Enhanced recovery, stomas and the community nurse. Br J Community Nurs 18(5): 214–20 Chandler P (2013a) Stoma care: the use of loperamide in ileostomy care. Gastroint Nurs 11(4): 11–12 Chandler P (2013b) Management of a prolapsed stoma. Gastroint Nurs 11 (5): 12–14 Cronin E (2013) Dietary advice for patients with a stoma. Gastroint Nurs 11(3): 14–24 Dukes S (2010) Considerations when caring for a person with a prolapsed stoma. Br J Nurs 19(17): S21–6 Fearon KCH, Ljungqvist O,Von Meyenfeldt M et al (2005) Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24: 466–77 Herlufsen P, Olsen AG, Carlsen B et al (2006) Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs 15(16): 854–62 Martins L, Tavernelli K, Sansom W et al (2012) Strategies to reduce treatment costs of peristomal skin complications. Br J Nurs 21(22): 1312–15 Notter J, Chalmers F (2012) Living with a colostomy: a pilot study. Gastroint Nurs 10(6): 16–24 Persson E, Berndtsson I, Carlsson E, Hallén AM, Lindholme E (2009) Ostomy related complications and ostomy size: a two year follow-up. Colorectal Dis 12(10): 971–6 Rudoni C (2011) Peristomal skin irritation and the use of a silicone-based barrier film. Br J Nurs 20(16): S12–18 Smith L, Boland L (2013) High output stomas; ensuring safe discharge from hospital to home. Br J Nurs 22(5): S14–18 Smith AJ, Lyon CC, Hart CA (2002) Multidisciplinary care of skin problems in stoma patients. Br J Nurs 11(5): 324–30
The Welland® Hyperseal® low profile, mouldable washer is the most cost effective option when compared to other leading brands*
Don’t let this be the only cost saving on your mind! Hyperseal low profile washers provide a cost effective solution to problematic stomas. A wide variety of stoma shapes and sizes are encountered during daily clinical practice. Issues such as leakage, peristomal itching and dermatitis can all be encountered and may not be resolved by using traditional methods of paste alone. Hyperseal washers are easily moulded to the correct shape or size, removing the need for scissors and templates. Available in two sizes, Hyperseal washers are suitable for all types of stoma and can provide a cost effective solution to problematic stomas by preventing pouch leaks and sore skin. Welland Hyperseal washers provide better healthcare results without increased cost.
For free samples of: ®Hyperseal Washers Small ®Hyperseal Washers Large please complete the coupon and return it to: CliniMed Ltd., FREEPOST HY241, High Wycombe, Bucks. HP10 8BR (NO STAMP REQUIRED), call our free confidential careline 0800 036 0100 or visit www.clinimed.co.uk Name: ________________________________________ Position: _____________________________________ Hospital/PCT: ____________________________________________ Address ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Postcode: ______________________ Tel No.: _______________________________________ Email: _______________________________________________________________________________________________ I do not wish CliniMed Limited or SecuriCare (Medical) Ltd to keep my personal information on their database or to update me with new information. CliniMed®, Welland® and Hyperseal® are registered trademarks of CliniMed (Holdings) Ltd. Cavell House, Knaves Beech Way, Loudwater, High Wycombe, Bucks. HP10 9QY. ©2011 CliniMed Ltd. CliniMed Ltd. is registered in England and Wales CRN1646927. Registered Office as above.
378
© 2013 MA Healthcare Ltd
*Drug Tariff price April 2011.
1379/0411/1
British Journal of Community Nursing Vol 18, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 22, 2015. For personal use only. No other uses without permission. . All rights re
Stoma complications: an overview Jennie Burch
Jennie Burch is Enhanced Recovery Nurse Facilitator, St Mark’s Hospital, Harrow, Middlesex
T
© 2013 MA Healthcare Ltd
here are about 102 000 people with a stoma in the UK (Black, 2009).There are three main types of stoma that the community nurse may encounter: colostomy, ileostomy and urostomy (Burch, 2008). The community nurse is not expected to be an expert on stomas and can contact the stoma specialist nurse in the local hospital for assistance with issues that do not resolve. However, it is possible that some common complications may be resolved without specialist stoma nurse input. This article aims to provide up-to-date information to assist the community nurse in caring for this patient group. If stoma accessories are appropriately applied, the community nurse may be able to reduce the overall prescription cost of products used. The colostomy is the most common type of stoma and is formed from the colon, usually to treat rectal cancer.The most common position for a colostomy is the left iliac fossa, between the navel and the hip bone. A colostomy is usually red or pink, is minimally raised above the skin by a few millimetres and is warm and moist to the touch. The output from a colostomy is formed faeces and flatus collected and contained in a closed stoma appliance. An ileostomy is formed from the ileum, often in order to treat people with inflammatory bowel diseases such as ulcerative colitis. The most common position for an ileostomy is the right iliac fossa. An ileostomy appears as a small spouted stoma (Cronin, 2013) of about 25 mm, and the output is loose faeces and flatus collected and contained in a drainable stoma appliance. An ileostomy appliance is generally replaced on a daily or alternate-daily basis and is emptied four to six times daily. A urostomy or ileal conduit is formed from the ileum and can be surgically formed to treat bladder cancer, for example. When the bladder is removed, the ureters attaching the kidneys to the bladder are cut away from the bladder and stitched onto a small segment of ileum. One end of the ileum is attached to the skin as the urostomy and the other end is oversewn to prevent urine from leaking into the abdomen. The urostomy has the same appearance and is in the same position as an ileostomy, but will pass urine and a small amount of mucus into a drainable bag with a bung or tap fastening. The urostomy appliance is generally replaced on a daily or alternate-daily basis and is emptied four to six times daily.
Stoma complications Complications can occur for a person with a stoma (ostomate) and it is likely that most ostomates will experience one or more problems with their stoma at some time. Some common complications may be resolved without specialist stoma nurse input. These include sore peristomal skin, constipation, diarrhoea and urinary infections. The following sections discuss possible
British Journal of Community Nursing Vol 18, No 8
Email: [email protected] complications and good practice that may actually help to alleviate the overall costs associated with such treatments.
Stoma accessories Martins et al (2012) argue there are high costs associated with peristomal skin problems that can be reduced with the appropriate use of stoma accessories. Herlufsen et al (2006) report that almost half of all ostomates use an accessory to enable them to have a secure stoma appliance. Notter and Chalmers (2012) suggest that half of people with a colostomy no longer receive specialist follow-up. Thus, the patient is likely to contact the community nurse for assistance if a complication occurs with their stoma. Although Persson et al (2009) consider that appropriate follow-up and treatment can prevent problems, there is no standardised follow-up procedure with the stoma specialist nurse for ostomates in the UK. ‘Enhanced recovery’ is a term used to describe evidencebased care of patients in the period before, during and after their surgery (Burch, 2013). This care pathway was initially used for patients undergoing colonic bowel surgery, but it is also now used for patients undergoing stoma-forming surgery and other operations such as orthopaedic and gynaecological surgery. Enhanced recovery aims to reduce the stresses of surgery and results in patients having fewer complications and a shorter length of hospital stay. The aims of enhanced recovery are to increase fitness before the operation and to resume daily activities such as eating, drinking and mobilising much sooner than was previously thought possible. Intravenous fluids and urinary catheters are removed soon after surgery—often on the day after the operation—resulting in fewer infections such as urinary infections. It is common for patients to leave hospital just 4 or 5 days after major surgery and in a better physical condition than with traditional care (Fearon et al, 2005). This may represent a significant improvement in terms of both patient outcomes and overall cost.
Sore peristomal skin Community nurses are generally very experienced at caring for wounds, but some wound care treatments are unsuitable for use with a stoma appliance. The usual wound care procedures should still apply, i.e. assessing the problem, planning and implementing a treatment and then evaluating its effectiveness. Peristomal skin should have the appearance of the rest of the abdominal skin and should be healthy and intact. Sore peristomal skin was reported by three quarters of ostomates in one study (Smith et al, 2002).This is a significant potential complication that requires efficient and effective treatment. A variety of severities can be experienced when the sore peristomal skin is assessed. Skin may simply be red (erythema),
375
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 22, 2015. For personal use only. No other uses without permission. . All rights re
CLINICAL UPDATE
376
Constipation A person with a colostomy is at risk of constipation in the same way as someone who has not had stoma-forming surgery. It should be noted that constipation cannot occur with an ileostomy. Ideally, constipation would be prevented, but if it does occur, there are a number of potential treatment options. Oral laxatives can be taken in the same way as a person without a stoma. It is also possible to use a suppository, but with some minor changes to insertion techniques. When a suppository is inserted into a colostomy it is liable to fall out of the stoma. Thus, the suppository needs to be held in situ for about 15 minutes. The stoma should initially be gently digitated with a gloved finger, then a suppository should be gently inserted into the colostomy and pushed as far inside as possible. The appliance should then be adhered quickly. Guide the colostomate’s fingers over the appliance and over the entrance of the colostomy and ask them to hold this position for about 15 minutes to allow time for the suppository to dissolve.
Diarrhoea A colostomate can have an infection and thus may develop diarrhoea. This should be treated after a stool test, using the appropriate antibiotics. Chemotherapy can also cause diarrhoea for people with a colostomy. While the diarrhoea persists, it can be advantageous to use a drainable stoma appliance to collect the loose faeces and to prevent the peristomal skin from being stripped and damaged by frequent appliance changes. Good hand hygiene needs to be explained to the ostomate to prevent re-infection of the patient themselves or those close to them. An ileostomate will usually pass porridge-like stool which can become thicker and looser depending on what the person eats and drinks throughout the day, with an average output volume of 600–800 ml daily (Black, 2000). It is possible that an ileostomate will become dehydrated if they do not pay attention to their dietary intake, and this can result in an electrolyte imbalance. People with an ileostomy therefore absorb sodium less effectively and can become sodium depleted if they do not take a little extra salt each day once they have an ileostomy (Smith and Boland, 2013). It is essential to consume adequate fluids to make up for the extra fluid lost in the loose stool: about 2000 ml daily is adequate for most ileostomates (Chandler, 2013a), and volumes of fluids consumed should not be dramatically higher than 2 litres. Consumption of carbohydrates with a reduction in the volume of fruit and vegetables will help to thicken the output from the ileostomy. Medication such as loperamide (possibly with codeine phosphate in addition) can also be used. In cases when the stomal output is consistently above 1000 ml daily, rehydration solutions can be useful.
Prolapsed stoma A stomal prolapse can be described as a protruding stoma that can be 10 cm or more in length. It is more common with a transverse colostomy, causing a dragging sensation. The risk of the stoma being damaged due to the bowel being outside the body is a significant one, and this may result in ulceration, bleeding and necrosis in extreme cases
© 2013 MA Healthcare Ltd
it may be broken and wet, or there may be erosion. The cause of the sore skin can also help to determine the treatment used. For erythema, the cause might be the stomal output touching the skin and causing damage.This can even progress to erosion in severe cases. The cause of the sore skin might be determined by looking at the appliance as it is removed to see whether there is anything visible to indicate a leak under the appliance flange (the adhesive part of the stoma appliance). Leaks might be due to a skin crease near the stoma, for example. Another cause of sore peristomal skin can be that the aperture in the flange is too large. This can occur when the postoperative stoma oedema resolves but the ostomate (person with a stoma) still cuts the hole to the same size. The postoperative stoma oedema can resolve for about 8 weeks following the stoma formation; in some cases there might be little alteration in the size of the stoma, but some can dramatically reduce in size.When observing the appliance and the stoma, the sore skin will often present as a halo of erythema around the stoma.This can worsen if left untreated, but, if caught early, the ostomate might simply report itching around their stoma as a result of the stomal output touching the skin and causing an irritation. In this situation it might be possible to treat by resizing the aperture in the flange. The flange is made of hydrocolloid and thus has healing properties that can heal sore peristomal skin without any other stoma accessory being utilised—clearly an efficient and effective treatment. If the cause of the sore skin is due to a skin dip or crease, this needs to be resolved by using a stoma accessory to level out the dip or crease. Accessories such as stoma adhesive paste or seals (also known as washers) may also be used in this situation. For erythema, the skin might simply require protecting by using a barrier film (Rudoni, 2011) to coat and protect the skin from the faecal or urinary output, or to protect from skin stripping. A protective film comes in the form of a wipe, spray or wand and there are a variety of manufacturers of this type of product. Some protective films contain alcohol and should therefore be used with caution if the skin is actually broken, as this will sting the ostomate. If the cause of the sore peristomal skin is due to skin cells being stripped when the appliance is removed, one treatment might be to retrain the ostomate to remove the appliance more gently, or to use an adhesive remover when the appliance is removed. The adhesive remover will prevent discomfort associated with appliance removal. If the peristomal skin is broken, effective treatment might be to use a small amount of stoma powder. The powder is especially formulated to absorb fluid from the oozing skin, to protect the skin and to allow the stoma appliance to adhere to the damp skin (Boyles, 2010). Caution should be exercised to ensure that too much powder is not used as this can result in the powder clogging up under the appliance, causing a leak. Another potential treatment choice for broken oozing skin is the use of a cool hairdryer. This is a treatment that is readily available to ostomates, but should be used with care as a hot hairdryer can burn the peristomal skin.When using a hairdryer it is important to keep it moving and to keep it away from the body to prevent inadvertent damage to the peristomal skin.
British Journal of Community Nursing Vol 18, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 22, 2015. For personal use only. No other uses without permission. . All rights re
CLINICAL UPDATE (Chandler, 2013b). The ostomate should be instructed to observe the mucosa of the stoma to ensure that it is not being damaged and to take care not to damage it during daily activities. Although surgery can be undertaken, conservative treatment is often advocated. It might be necessary to use a larger capacity stoma appliance to ensure that the bowel and effluent are contained (Dukes, 2010).
Urinary infection If a urostomate has a urine infection, this may be evident by an odour, increased mucus and cloudy urine. It should be noted that a urine sample should not be taken from the urostomy appliance but instead by gently catheterising the urostomy. Antibiotics can then be used to treat the infection.To prevent a urine infection the urostomate should be encouraged to drink 2000 ml of fluids daily. Cranberry juice may help to prevent infections if consumed daily, and can be an effective and efficient treatment.
Conclusion It can be seen that there are a variety of problems associated with stomas. The community nurse can assist ostomates with some simple techniques or advice. Sore skin needs to be carefully assessed to ensure that the cause is addressed and treated. Treatment may be as simple as checking the size of the aperture in the stoma appliance and resizing it. Importantly, by using stoma accessories appropriately, the community nurse may be able not only to resolve problems associated with the stoma, but also to reduce the cost of stoma products used in order to
achieve a secure appliance seal. Other issues such as diarrhoea, constipation and a urine infection can also often be treated in a similar way to people without a stoma. BJCN Black P (2000) Holistic Stoma Care. Balliere Tindall, London Black P (2009) Managing physical postoperative stoma complications. Br J Nurs 18(17): S4–S10 Boyles A (2010) Stoma and peristomal complications: Predisposing factors and management. Gastroint Nurs 8(7): 26–36 Burch J (2008) Stomas: the past, present and future. In: Burch J, ed. Stoma Care. Blackwell Wiley, West Sussex. Burch J (2013) Enhanced recovery, stomas and the community nurse. Br J Community Nurs 18(5): 214–20 Chandler P (2013a) Stoma care: the use of loperamide in ileostomy care. Gastroint Nurs 11(4): 11–12 Chandler P (2013b) Management of a prolapsed stoma. Gastroint Nurs 11 (5): 12–14 Cronin E (2013) Dietary advice for patients with a stoma. Gastroint Nurs 11(3): 14–24 Dukes S (2010) Considerations when caring for a person with a prolapsed stoma. Br J Nurs 19(17): S21–6 Fearon KCH, Ljungqvist O,Von Meyenfeldt M et al (2005) Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24: 466–77 Herlufsen P, Olsen AG, Carlsen B et al (2006) Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs 15(16): 854–62 Martins L, Tavernelli K, Sansom W et al (2012) Strategies to reduce treatment costs of peristomal skin complications. Br J Nurs 21(22): 1312–15 Notter J, Chalmers F (2012) Living with a colostomy: a pilot study. Gastroint Nurs 10(6): 16–24 Persson E, Berndtsson I, Carlsson E, Hallén AM, Lindholme E (2009) Ostomy related complications and ostomy size: a two year follow-up. Colorectal Dis 12(10): 971–6 Rudoni C (2011) Peristomal skin irritation and the use of a silicone-based barrier film. Br J Nurs 20(16): S12–18 Smith L, Boland L (2013) High output stomas; ensuring safe discharge from hospital to home. Br J Nurs 22(5): S14–18 Smith AJ, Lyon CC, Hart CA (2002) Multidisciplinary care of skin problems in stoma patients. Br J Nurs 11(5): 324–30
The Welland® Hyperseal® low profile, mouldable washer is the most cost effective option when compared to other leading brands*
Don’t let this be the only cost saving on your mind! Hyperseal low profile washers provide a cost effective solution to problematic stomas. A wide variety of stoma shapes and sizes are encountered during daily clinical practice. Issues such as leakage, peristomal itching and dermatitis can all be encountered and may not be resolved by using traditional methods of paste alone. Hyperseal washers are easily moulded to the correct shape or size, removing the need for scissors and templates. Available in two sizes, Hyperseal washers are suitable for all types of stoma and can provide a cost effective solution to problematic stomas by preventing pouch leaks and sore skin. Welland Hyperseal washers provide better healthcare results without increased cost.
For free samples of: ®Hyperseal Washers Small ®Hyperseal Washers Large please complete the coupon and return it to: CliniMed Ltd., FREEPOST HY241, High Wycombe, Bucks. HP10 8BR (NO STAMP REQUIRED), call our free confidential careline 0800 036 0100 or visit www.clinimed.co.uk Name: ________________________________________ Position: _____________________________________ Hospital/PCT: ____________________________________________ Address ___________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Postcode: ______________________ Tel No.: _______________________________________ Email: _______________________________________________________________________________________________ I do not wish CliniMed Limited or SecuriCare (Medical) Ltd to keep my personal information on their database or to update me with new information. CliniMed®, Welland® and Hyperseal® are registered trademarks of CliniMed (Holdings) Ltd. Cavell House, Knaves Beech Way, Loudwater, High Wycombe, Bucks. HP10 9QY. ©2011 CliniMed Ltd. CliniMed Ltd. is registered in England and Wales CRN1646927. Registered Office as above.
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© 2013 MA Healthcare Ltd
*Drug Tariff price April 2011.
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British Journal of Community Nursing Vol 18, No 8
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