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Statement of Clinical Problem: Hardware such as a loop ostomy rod or DeMartel clamp for loop ostomies is associated with difficulty in applying the stoma appliance until removal of the rod.1 A poor fitting appliance can result in leakage of fecal matter onto the skin and thus skin irritation.
Description of past management: When a rod is sutured in place or too large to include in the skin barrier, common practice was to apply stoma paste over the rod and place a cut-to-fit ostomy system directly over the rod. When the rod is not sutured down it could be manipulated to fit within the pouching system, however, accidental dislodging of the rod could occur. Securing the seal and wear time for either technique was not ideal or predictable. In addition, the multitude of steps and products needed, created stress for the patient and caregiver.
Current Clinical Approach: With the goal to create a secure seal to help prevent leakage under the skin barrier and subsequent peristomal irritation, we evaluated a moldable skin barrier.* The moldable skin barrier was rolled to the shape of the stoma, manipulated to fit securely around the stoma and covered the rod. Once in place the moldable skin barrier was held in place for 60 seconds. Stoma paste was not applied.
Patient Outcomes: A secure seal was achieved, helping to keep the peristomal skin healthy. Rods and sutures were not dislodged even when covered with the moldable skin barrier. Less patient anxiety and discomfort was observed due to less manipulation of the loop ostomy rod.
Conclusion: The moldable skin barrier provided a secure seal while reducing the number of steps and products required for pouching a stoma with hardware present. The staff and patients were less intimidated thus making teaching and pouch changes easier.
Description of past management: When a rod is sutured in place or too large to include in the skin barrier, common practice was to apply stoma paste over the rod and place a cut-to-fit ostomy system directly over the rod. When the rod is not sutured down it could be manipulated to fit within the pouching system, however, accidental dislodging of the rod could occur. Securing the seal and wear time for either technique was not ideal or predictable. In addition, the multitude of steps and products needed, created stress for the patient and caregiver.
Current Clinical Approach: With the goal to create a secure seal to help prevent leakage under the skin barrier and subsequent peristomal irritation, we evaluated a moldable skin barrier.* The moldable skin barrier was rolled to the shape of the stoma, manipulated to fit securely around the stoma and covered the rod. Once in place the moldable skin barrier was held in place for 60 seconds. Stoma paste was not applied.
Patient Outcomes: A secure seal was achieved, helping to keep the peristomal skin healthy. Rods and sutures were not dislodged even when covered with the moldable skin barrier. Less patient anxiety and discomfort was observed due to less manipulation of the loop ostomy rod.
Conclusion: The moldable skin barrier provided a secure seal while reducing the number of steps and products required for pouching a stoma with hardware present. The staff and patients were less intimidated thus making teaching and pouch changes easier.