Use of a moldable skin barrier with adhesive coupling to manage severely denuded peristomal skin

 

Problem:  Many patients have anatomically compromised stomas due to surgical process and limited placement options.  An ostomy appliance which does not fit properly will lead to skin breakdown.  The three following patients had severely denuded skin due to high liquid output, poor fitting appliance and anatomically challenged stoma placement.

Solution:  We chose to evaluate a cut to fit adhesive coupling two-piece ostomy system for these patients because of the flexibility and versatility of the appliance.  The adhesive coupling allows for greater mobility/flexibility as the patient moves increasing wear time and decreasing the probability of leaking versus a traditional appliance with a plastic coupling ring.  We applied the product as a two-piece system in order to get a close, secure fit around the stoma.  Because there is no protruding coupling ring, the system better contoured to the shape of the patients’ abdomens, providing the needed flexibility and seal for better wear time.  Cohesive seals*** were used in conjunction with the pouching system to enhance seal leading to a longer wear time.

Results:  The severely denuded skin resolved for all three patients with the use of this new pouching system.  Maximum wear time was 3 days.  Patient satisfaction was high related to ease of use and reasonable wear time. 

Conclusion:  Because of the success our patients experienced with the adhesive coupling ostomy system*, we initiated bringing this product into our facility.  The new technology is now available in moldable skin barriers** which allow for greater versatility for patients and staff as the appliance can be utilized as a 1 or 2 piece system.  Other benefits we are beginning to see include increased independence for patients with limited dexterity or eyesight, and increased staff satisfaction due to simplicity and time savings.