Steps for postoperative pouch application

STEPS

  1. Be organised: gather all the supplies, including any written step-by-step instructions or family education literature before beginning the procedure.
  2. Select a pouching system based upon the child's size. Use extra-small paediatric pouches on children under 4.5 kg-they provide flexibility and contouring for the abdominal surface.
  3. Empty the previous pouch into a nappy or container before removing. Older children can sit on the toilet to empty their pouch. Use one hand to support the skin and the other hand to lift the skin barrier, gently removing it without "tenting up" the skin. You may use warm water and gauze or a moist paper towel to ease removal.
  4. Wash the skin around the stoma using a warm, moist paper towel or gauze. Avoid using soaps as much as possible since they often leave a residual film on the skin that may interfere with pouch adherence. A small amount of bleeding is normal.
  5. Look at the stoma to assess the colour.
  6. Look at the skin around the stoma. The epidermis may or may not be intact. If there is no peristomal skin compromise, apply a protective, nonalcohol skin barrier wipe to the surface area where the skin barrier will adhere.
  7. Measure the stoma-find the circle size on the stoma measuring guide that fits closest to the stoma without touching it. This will ensure that the opening to be cut in the skin barrier fits closest around the stoma without touching it. Smooth the inner edges with your finger to avoid any trauma to the stoma. If it is cut too small, the skin barrier may possibly cut or irritate the stoma or compromise blood flow to the stoma.
    Note: Many children may need to use Stomahesive ® Paste or skin barrier rings applied directly onto the skin or on the adhesive side of the skin barrier to improve adherence. This is particularly important for those who have a thinner stool consistency.
  8. Apply the new pouching system to the skin around the stoma. Centre the opening over the stoma and gently press the skin barrier onto the skin for 2 to 5 minutes.
  9. Close the pouch and wash your hands.
  10. It is recommended that you allow the child to decide whom they may tell or not tell about their stoma within reasonable parameters.

SPECIAL TIPS

  • In a prolapsed stoma, cut the opening in the skin barrier to fit the base of the stoma. In addition, it is helpful to cut small ~1-cm-long "snips" at the 12:00, 3:00, 6:00, and 9:00 o'clock positions to allow for the natural movement of the bowel at the abdominal surface and avoid any trauma to it. Apply Stomahesive ® Paste to the skin around the base of the stoma or around the opening cut in the skin barrier about the same thickness you would put toothpaste onto a toothbrush. For smaller children, it may be helpful to squeeze Stomahesive ® Paste into a 5 to 10 cc syringe, then apply a thin line of it around the opening cut in the skin barrier.
  • If peristomal skin is denuded due to contact with effluent, apply a layer of Stomahesive ® Paste to denuded areas only, then "seal" powder with a nonalcohol skin barrier wipe.

TROUBLESHOOTING POTENTIAL SKIN PROBLEMS

Skin Condition Common Problem Source Common Recommendations

The skin is red, moist, and sore. The redness may be localised to the site of the leakage.

Irritant contact dermatitis usually happens when the pouch or skin barrier leaks, causing redness and irritation.

Dust the skin with adhesive powder, brush off the excess. If the irritation is more severe, dab barrier wipes over the powder and let the area dry before reapplying your pouching system.

TIP: The best prevention is a secure fit. The opening of the appliance should lie no more than 0.3 cm away from the base of the stoma all the way around. Also: Empty the pouch when it's one-third full, and change the appliance if the patient has any burning or irritation, even if you or the patient do not feel or see obvious signs of leakage.

 

The skin may be red, weepy, and painful to the touch.

Mechanical trauma that occurs when you remove adhesives or equipment too quickly or harshly-doing so may damage the first layer of skin around the stoma.

Work with the healthcare professional to figure out what is causing the damage and correct it. Then apply a dusting of protective powder and brush off any extra so the barrier will stick. You may wish to use a light coating of a protective skin barrier using a wipe such as ConvaCare ® Protective Barrier following the application of the powder to help ensure adhesion to skin.

TIP: Remove adhesives slowly and use adhesive remover wipes if the problem persists. To avoid lacerations, make sure the skin barrier is not cut too close to the stoma.

 

May include intense itching, patchy red skin, inflammation, and tiny bumps that progress outward from lesions.

Candidiasis-a yeastlike fungal infection caused by Candida albicans, which grows in a warm, wet, closed environment.

Check for leakage and refit your pouching system if necessary. Talk to the healthcare professional, who may recommend that you apply antifungal powder (lotions or creams may undermine the pouch seal) to the affected area.

TIP: Change the pouching system more often, especially in a hot climate or with frequent hot tub use.

 

Raised, moist lesions with a wartlike appearance.

Pseudoverrucuous lesions are caused when urine leaks and pools under an oversized or improperly sized barrier, making the skin tissue appear "pruny"(similar to sitting in a bathtub too long). Painful lesions may develop.

Apply a light dusting of protective powder, followed by an application of a barrier wipe, and allow the area to heal. In severe cases, you may want to refer to a dermatologist.

TIP: Be on the lookout for leakage around the base of the appliance. Make sure the opening closely matches the stoma size. If not, you will need to remeasure the opening to minimise the skin's exposure to urine.

 

The skin may look red, swollen, moist, or stripped away where the appliance touches the skin. The affected area often occurs in the same shape as the product that's contacting the skin.

Allergic contact dermatitis, which occurs when sensitive skin reacts to something in the skin barrier, tape, or pouch.

Stop using the product causing the reaction. A light coating of Orahesive ® Powder can help absorb moisture, helping to prevent and protect denuded or weeping skin. Consult with the primary healthcare professional; depending on the severity, you may need to recommend a dermatologist.

Please see package insert for complete instructions for use.



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