Case : Peristomal Ulcer Care with Cadexomer Iodine Ointment

Case : Peristomal Ulcer Care with Cadexomer Iodine Ointment

Kim Hye Sook, Kim Hee Joung

Ajou University Medical Center

Keyword : Peristomal ulcer, Cadexomer Iodine Ointment, Stomahesive powder

Abstract

Introduction

According to a study published by Cottam et al. in 2007, complications of colostomy occurred in 34% of patients who had stoma in 3 weeks after enterostomy and among those complications of colostomy,  mucocutaneous separation accounted for 24% and necrosis  8.7%. Among 11.9% of patients who took enterostomy at A hospital in S city of South Korea from May 2008 to January 2009, peristomal ulcer or mucocutaneous separation was incurred. It often resulted in delayed discharge from the hospital. Peristomal ulcer may result from various causes such as malnutrition, steroid therapy, excessive tension given to stoma and skin suture line, or enterostomy in patients with peritonitis, etc.

Purpose

When patients with stoma who suffered from peristomal ulcer were trained about the traditional method(filling dead space with stomahesive paste or hydrofiber, conducting secondary dressing with hydrocolloid etc., and then pouching it), they complained about difficulties in dressing methods including aseptic technique, thus a new method was sought for to  more easily care peristomal ulcer and prevent contamination caused by the frequent leakage of a skin barrier. The authors introduce a case study of how to successfully care  peristomal ulcer with 0.9% cadexomer iodine ointment.

Method

0.9% cadexomer iodine ointment was applied to the peristomal ulcer site by the skin level, skin protective powder and skin protective film were sprayed repeatedly 3 times (crusting method), the gap was filled with skin protective ointment, a two-piece skin barrier was used, and they were directed to wear a stoma belt for patients with peristomal ulcer   among those who took enterostomy at A hospital located in S city of South Korea. Patients with stoma and their guardians were trained to care for themselves every 3~4 days during hospitalization, and the peristomal ulcer condition was followed up when they visited the hospital after they had left the hospital and cared for themselves at home.

Conclusion

It is known that  if the skin around stoma is damaged, patients have physical discomfort and become down in the depth of  despair of stoma care, leading to more burden on skin care and ultimately the less quality of life. In this case study, patients simply applied ointment and repeated the traditional crusting method at intervals of 3~4 days, leading to a good outcome that peristomal ulcer could be healed up without leakage while the attachment was retained. Consequently, the suggested method could reduce a burden of patients and their guardians on skin care and improve their quality of life without extension of hospitalization.