Cath Lab Digest

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Abstract: Ostomy skin barriers can be difficult to size and shape; gaps between the skin and the appliance can compromise peristomal skin protection. A multicenter evaluation was initiated to assess the satisfaction of persons with ostomies (n = 172, mean age 56.6 years) and enterostomal therapy nurses (ETs, n = 49; number of evaluations = 195) with a new moldable skin barrier. The majority (116) of participants had ostomy surgery >90 days before the evaluation. Study participants received up to five product samples. Evaluation forms included stoma background information and questions regarding the product’s ease of application and molding, ease of creating a customized fit, adherence of the hydrocolloid collar, ability to shape and reshape, effectiveness of skin protection, level of satisfaction with the product, and concerns/problems. At baseline, skin irritation was noted in 41% of ET evaluations and by 46% of participants with a stoma and cited as a reason to discontinue product usage in 11 ET reports (6.4%) and by seven users (3.6%). Regardless of the type of ostomy surgery, the percentage of “very good”/“excellent” ratings from participants for all evaluation criteria was 84.2% for colostomies, 85.4% for ileostomies, and 92.5% for urostomies. Similarly, for the ET evaluations, the percentage of “very good”/“excellent” ratings for all evaluation criteria was 89.0% for colostomies, 92.7% for ileostomies, and 92.7% for urostomies and 87% of ETs noted that teaching product usage was easy. Although interpretation of the results is limited by the study design, these findings confirm previous reports that the prevalence of skin irritation among ostomy patients is high and suggest that the barrier evaluated is comfortable and easy to use. Controlled clinical studies to compare the safety and effectiveness of ostomy appliances as well as their effect on patient quality of life are needed.

Key Words: evaluation, peristomal skin, ostomy, skin barrier, safety

Ms. Hoeflok is an Advanced Practice Nurse, Gastroenterology/General Surgery, St. Michael’s Hospital, Toronto, Ontario. Ms. Guy is an Ostomy/Wound Care Specialist/Consultant, Central Health Region, Gander, Newfoundland. Ms. Allen is an Enterostomal Therapy Nurse, Alberta Health Services, University of Alberta Hospital/Stollery Children's Hospital, Edmonton, Alberta. Ms. St-Cyr is a Nurse Clinician, Enterostomal Therapy Department, McGill University Health Centre, Montreal, Quebec. Please address correspondence to: Jo Hoeflok, St. Michael's Hospital, Room 16-078 CC, Toronto, Ontario M5B 1W8; email: Jo Hoeflok Hoeflokj@smh.toronto.on.ca.

     Mastering selection and application of a pouching system is an important concern for an individual living with an ostomy. Effective patient education enables the individual to gain independence and confidence with routine care as well as pouching system application. Ideally, this education process begins in the pre-operative phase, progresses through hospital discharge, and continues to outpatient follow-up with an Enterostomal Therapy (ET) nurse or non-specialized nurse. Appropriate ostomy pouching system selection is of utmost importance across the continuum of care.

     A well-recognized goal in ostomy care is to ensure a secure seal to protect the stoma and maintain peristomal skin protection. Choosing a system to achieve these goals will depend on how the stoma is shaped and whether it protrudes or is flush (flat) with the skin.