Problem Statement: Perineal dermatitis and pressure ulcer formation are potential outcomes of prolonged skin contact with stool, especially liquid stool, due to presence of active digestive enzymes. The availability of catheter-based systems for the management of stool in patients in all types of settings presents an opportunity for protection of intact skin and reduction of moisture and soiling of existing wounds in the sacral area.

Past Management and Current Approach: Three clinical cases will be described, each with unique needs for skin protection. The methods of bowel management will be described, along with key demographic and clinical information about the patients. The impact on patient, family members and nursing staff will be evaluated, using a comparison between traditional management techniques and a new approach using a catheter-based system*.

Conclusions: The catheter-based system has applications in acute, long-term care, and home-care settings. Careful patient selection and timely education of caregivers were integral steps to achieving successful outcomes. Keys to success include in depth physical assessment to make sure potential patient is a good candidate, having several members of staff in any setting who are trained extensively in the system's use available for initial placement and follow-up support, and an individualized irrigation plan to assure stool drains properly. If the above needs are properly addressed, the benefits of implementing the use of a catheter-based bowel management system can be measured in many ways. Skin health, staff satisfaction, time saved and decreased patient care costs may all be positively affected.

* Zassi Bowel Management System, Hollister Incorporated, Libertyville, IL

The support of Hollister Incorporated for this project is gratefully acknowledged