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.
The Ostomy Files
Choosing a Skin Barrier
- Mon, 12/12/11 - 12:40pm
- 0 Comments
- 815 reads
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.
The Ostomy Files: Ostomy Accessories
- Mon, 9/12/11 - 1:23pm
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- 932 reads
Ostomy Wound Management will publish The Ostomy Files on an occasional basis to provide information and options for clinicians caring for people with all types of ostomies.
The DialogueStudy1 found that 61% of patients have a peristomal skin problem as assessed by their WOC nurse. The main cause is stoma effluent coming in contact with the peristomal skin. Body shape and skin type are as individual as personality—some people can establish a good seal between the skin and the barrier, but others may find it a challenge getting a tight seal to avoid leakage and may need a little extra help to make their ostomy appliance fit securely and to care for peristomal skin.
A Resource for the WOCN to Support Health Literacy Post Discharge
- Thu, 11/11/10 - 4:59pm
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- 1803 reads
Health literacy can be defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”1 According to the Centers for Disease Control and Prevention,1 only 12% of adults have the skills needed to effectively manage their health and prevent disease.
A Content-Validated Tool to Effectively Document Peristomal Skin Lesions
- Thu, 10/14/10 - 1:47pm
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- 1796 reads
Peristomal skin disorders can lead to patient frustration and poor quality of life, making early intervention and effective management paramount. A recent cross-sectional study by Herlufsen et al1 found that 45% of people with permanent stomas had peristomal skin disorders and 76% of these problems lasted more than 3 months.
The Ostomy Files: A Validated Ostomy Care Algorithm: Applications to Clinical Practice
- Mon, 5/10/10 - 4:45pm
- 1 Comments
- 3081 reads
An algorithm is a step-by-step procedure designed to solve a specific problem by advancing through a series of pre-determined logical steps. Initially used in computers and digital processing, algorithms now are used for many diagnostic and therapeutic problems in medicine and healthcare.1
When algorithms are designed to promote safe patient care, they must have established validity and reliability. Validity entails two aspects: content and construct. The algorithm must have research evidence demonstrating inclusion of the items or components (content) appropriate to its use (eg, o
Two New Tools for Your Ostomy Practice
- Fri, 12/11/09 - 1:42pm
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- 3167 reads
Caring for people with intimate healthcare needs such as an ostomy is a great responsibility. Traditionally, ostomy clinicians learn the tricks-of-the-trade from preceptors, mentors, and patients. But as in all of medicine and nursing, as we strive for better outcomes we recognize the need to rely on the scientific method to provide improved, consistent results. Reviewing the literature for information on ostomy issues presents additional challenges because study results reflect differing methods of assessment and data collected and many variables, confounding the evidence
Understanding Skin Barriers
- Tue, 5/19/09 - 11:21am
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- 4195 reads
The skin barrier is the most important part of the pouching system. It protects the peristomal skin, holds the ostomy pouch in place, and provides a level pouching surface. Ideally, a skin barrier should mirror the shape of the peristomal plane. Thinner more flexible, erosion-resistant skin barriers available over the past decade are facilitating more variety in shape, depth, and degree of convexity and flexibility. Understanding how ostomy adhesives and accessory products are designed and work will help clinicians provide patients with the best pouching options.
Partners in Care
- Tue, 4/21/09 - 12:24pm
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- 3096 reads
My mother had ulcerative colitis (UC). I have spent a lifetime aware of frequent bathroom visits, restricted diets, irritability, and side effects from medications, such as bloating and fatigue. Ultimately, my mom underwent a total colectomy with end ileostomy just before her 70th birthday; despite the challenges of adjusting to a new body image and managing a pouching system, she wonders why she didn’t have surgery sooner. My mom’s experience reinforces the importance of providing counsel, product choices, and education for individuals undergoing ostomy surgery in ord
Who Are You?
- Thu, 2/5/09 - 5:12pm
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- 2146 reads
Ostomy Wound Management is pleased to announce the return of The Ostomy Files, now sponsored by Coloplast Corp. This series of occasional articles features no-nonsense tips and insights for providing compassionate, high-quality management of the patient with an ostomy.
As an ostomy clinician, you serve numerous purposes and play vital roles.
You are a clinical specialist. Not long ago, some patients had two choices: ostomy surgery or death. Surgery came with postoperative complications, long hospital stays, and no one to help patient
Quality of Life: Healing the Brain and The Body
- Wed, 9/3/08 - 10:25am
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- 3329 reads
Self-esteem is potent concern for anyone, and emotion cannot be denied.
- Richard Cohen, writer, The New York Times, on his feelings about his temporary ileostomy, April 2001
Q uality of life. Three words that carry enormous weight in any person's life, but especially in a life lived with a stoma. These three words are lobbed about in nearly every professional discussion of outcomes or cost of ostomies, as well as in the process of developing clinical tools and standards. But do we really know what they mean and are we really paying attention to and measuring quality of life (QOL)?
