What to do if the ostomy pouch won't stick?

Irritant dermatitis caused by effluent leaking on the skin is the most common type of peristomal skin complication¹. Treatment is usually directed at drying the skin and evaluating the appropriateness of the pouching system.  A pouching system should provide predictable wear time and protect the peristomal skin.  Products that are typically used to strengthen the pouch seal against the skin are adhesives.  Adhesives are available as contact cement, adhesive sprays, and pads/wands to wipe on liquid adhesives². Another option is a liquid skin protectant containing cyanoacrylate. Cyanoacrylates polymerize in the presence moisture such as seen with irritant dermatitis. The cyanoacrylate then sets up a polymer film that can be used to secure the ostomy pouch to the skin. Six patients ranging in age from 5 months to 85 with a history of irritant dermatitis that had failed conventional adhesive methods were followed. Four patients had ileostomies, one patient had an ileal conduit and the other patient had a jejunoduodenostomy. The peristomal skin was cleansed with water, dried, the cyanoacrylate was applied around the stoma, and then the pouch was applied. After the first application of cyanoacrylate, the presence of irritant dermatitis was decreased and patient satisfaction with their pouching system improved demonstrating that cyanoacrylate is another option that WOC nurses can use to provide a better ostomy pouch seal to decrease the peristomal complication of irritant dermatitis.