I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
A Descriptive Study to Assess the Impact of Surgical Stomas on Individuals’ Sleep Perceptions & Response to Sleep Hygiene
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44 Abstract: Multiple factors affect the sleep quality of individuals with surgically created stomas. Using Rogers’ Diffusion of Innovation as the theoretical framework, a study was conducted to: 1) assess subjective sleep quality perceptions and objective sleep measurement in adults with stomas, 2) determine if there is a correlation between subjective and objective measurement of sleep in this group, and 3) implement a stoma-specific sleep hygiene intervention to improve these sleep quality perceptions. Subjective assessment focused on sleep subset questions from the Stoma Quality of Life Index (SQOLI) and the Pittsburgh Sleep Quality Index (PSQI). Respondents’ (n = 26) subjective sleep scores were 7.23 mean global score on seven questions (PSQI, range: 0 [no difficulty sleeping] to 3 [severe difficulty sleeping], total 0 to 21) with a mean score of 7.32 on three questions (SQOLI, range 1 [severe difficulty sleeping] to 4 [no difficulty sleeping], total 0 to 12) on sleep subset questions; composite scores of 5 or greater (PSQI) and 3 or less (SQOLI) indicating sleep problems. Scores showed that adults with stomas have increased sleep disruption and poor sleep quality. Five respondents who met intervention enrollment criteria participated in an objective sleep assessment using actigraphy, overnight oxygenation studies, and a 4-week sleep hygiene intervention. Mean PSQI score improved by 1.20 but the difference was not statistically significant. Because the results of this study confirm that sleep problems are common in older adults with a stoma, larger sample size studies of >4 weeks’ duration are warranted. Until additional research results are available, the existence of sleep quality and overnight pouching concerns should be recognized and use of the low-cost, easy-to-use, stoma-specific sleep hygiene intervention considered.
Please address correspondence to: Ellen Vorbeck, DNP, APRN-BC, CWOCN, 220 Glen Ellen Drive, Mankato, MN 56001; email: Vorbeck.Ellen@mayo.edu.
Incontinent surgical diversions that create stomas have been performed since the 1700s; an estimated 70,000 to 100,000 stoma surgeries now are performed every year.1 The number of individuals with an incontinent stoma in the United States is estimated to be 450,000 to 500,000.2 Surgical formation of a permanent incontinent stoma is used to treat traumatic injury, cancer, Crohn’s disease, ulcerative colitis, perforated diverticulitis, anatomical malfunction, birth defect, and ischemia to the small or large intestine.2 For the purposes of this project, the term stomas will refer to ileostomies, colostomies, and urostomies.
The importance of sleep for health maintenance is well-documented in the literature.3-6 Ferrie et al7 found that consistent sleep duration of 7 to 8 hours nightly was a strong indicator of optimal health outcomes and decreased mortality. Recent advances in the study of sleep indicate that lost sleep causes alterations in respiratory and hormonal function.4-8 A healthy sleep-wake cycle also is critical for regulation of immune and neuroendocrine function.5,9,10 Sleep restriction or deprivation and chronic sleep loss increase healthcare utilization because of their negative impact on overall health.4,5,8 
Literature on the quality of life for individuals with stomas strongly suggests that factors associated with incontinent stomas affect sleep but studies to ascertain the relationship between incontinent stomas and sleep disruption have not been conducted.
Health, sleep, and sleep problems.
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