One of the most challenging issues associated with colostomy management is an improperly cited stoma, which may occur as the result of the absence of preoperative stoma site marking, emergency surgery, postoperative weight gain, or attempts to site the stoma in the operating room. In addition, obesity is epidemic across North American cultures. Each of these two issues is associated with unique obstacles related to ostomy management. A poorly sited colostomy alone or in combination with obesity creates major self-care, quality-of-life, and ostomy management difficulties.

  Improperly sited stomas often are placed in skin creases, fat folds, near previous scars or bony prominences, or in or around other topographical irregularities on the abdomen. What may be an ideal location for one patient can be a disastrous location for another patient. Stomal malplacement disregards the need for a flat peristomal skin surface onto which an ostomy pouching system can be adhered. Self-care may be negatively affected or impossible because the patient is unable to see the stoma. Obstacles to independent care and lack of predictable, reliable wear-time not only reduce the individual’s quality of life, but also may lead to chronic leakage, peristomal skin irritation, and subsequent increased costs of care.

Index: Ostomy Wound Manage. 2007;53(8):20-28.

  Stomal bleeding is usually caused by trauma,^1,2 skin excoriation, and stomal ulceration² and typically controlled by local measures that include local pressure, silver nitrate application, injection sclerotherapy, and suture ligation of the bleeding point.^2-6 Hemorrhage from stomal varices is a rare but potentially fatal cause of stomal bleeds. To increase clinician awareness about this complication, three recent cases involving patients with recurrent stomal bleeding secondary to stomal varices are described and management strategies are discussed.

Index: Ostomy Wound Manage. 2007;53(8):46-53.

  Clinicians in Ontario are continually challenged to provide quality patient care despite decreasing resources. Innovative programs that support patient-centered care, staff satisfaction, and nurse outcomes are needed, especially with regard to pressure ulcers.¹ A study conducted among 18 acute care facilities (4,831 patients) across Canada by Woodbury and Houghton² found a pressure ulcer prevalence rate of 24% to 26% in Canadian acute care hospitals between 1990 and 2003. Data were collected from peer-reviewed published literature and unpublished studies provided by the healthcare facilities or support surface companies sponsoring prevalence and incidence studies.