Cath Lab Digest

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  There are many options to consider when selecting the appropriate ostomy appliance for your patient, including pouch features (eg, the type of outlet, preference for a filter, opacity, cloth backing) and adhesives. A skin barrier should be selected that will provide a secure, protective seal around the stoma while maintaining optimal skin condition. With guidance from the WOCN, the patient has the ultimate decision over what works best for his/her lifestyle.

  Consider the skin: epithelial cells are bonded by a matrix of lipids and enzymes to create an acid mantle, providing protection from bacterial and fungal invasion. Metabolic processes produce perspiration. The natural process of cell death leads to the shedding of epithelial cells. The ideal ostomy skin barrier must manage skin function and process without breaking down or loosening and maintain an optimal skin pH to prevent fungal or bacterial invasion. Most importantly, it must adhere securely yet remove gently to avoid skin stripping or cause mechanical injury.

  Ostomy skin barriers are made up of a polymeric matrix (see Figure 1) and compounds (hydrocolloids) that provide absorption (eg, of perspiration), tack/stickiness (ie, the property relating to instantaneous bonding to the skin), and moldability to fit against the skin for long-term adhesion. Ostomy adhesives are pressure-sensitive. The long-term bond between skin and appliance depends on the adhesive making full contact with the skin surface and is achieved by applying gentle pressure upon application. This allows the polymers to flow into the skin, increasing the contact area (see Figure 2).

  Stomas with aggressive output often break down the adhesive; contact with stoma effluent is the most common cause of skin irritation, leading to skin problems and discomfort. Peristomal skin health is critical, because it can have a direct impact on the way the patient deals with a stoma, which directly affects his/her quality of life.¹ Research has demonstrated the most common reason for peristomal skin breakdown is chemical irritation of the skin — specifically, by stool or urine. This can be caused by an improper ostomy appliance fit, skin barrier erosion, or a combination of both. The OstomySkinStudy² revealed frequency of skin disorders was highest among participants living with an ileostomy (57%), followed by urostomy (48%). Of the peristomal skin disorders observed, 77% were due to skin exposed to stool or urine. Contact with stoma effluent is the most common cause (up to 48%)³ of skin irritation leading to skin problems and discomfort.

  Keeping the skin dry and healthy involves a combination of different compounds (hydrocolloids) with different moisture-absorbing capabilities. Different hydrocolloid combinations create a balance between initial absorption and absorption during use. Standard wear barriers absorb moisture quickly and may be considered in humid environments and for people who perspire heavily. Extended wear barriers absorb moisture at a slower rate and are indicated for use with liquid output.