Skin Barrier Selection in an Outpatient Ostomy Clinic

Statement of Clinical Problem: 

The lives of people living with ostomies are significantly impacted by their pouching systems.  Ill-fitting skin barriers cause leakage which can contribute to peristomal lesions and trauma to the stoma.  Peristomal dermatitis is also often attributed to sensitivity to acrylic adhesive collars of skin barriers.¹

Background:

The outpatient ostomy clinic sees patients with new ostomies within 2-weeks after discharge for post-op follow-up, as well as patients having problems with existing stomas.  The emotional stress associated with leakage and painful skin irritation  prompts patients to contact the ostomy clinic for help. Patients often talk about experiences with pouching system leakage.  Many have improperly cut their skin barrier, or have ill-fitting pouching systems, which has contributed to the problem.

Solution:

Skin barrier selection for optimal patient outcomes requires consideration of factors such as stoma size and shape, condition of peristomal skin, dexterity, eyesight and patient cognitive status.  As patients presented to our clinic, an evaluation of moldable skin barriers* was implemented.

Results:

In a 6-month period, 70 patients, with new and existing ostomies have had appointments for assessment by a WON.   Approximately 25% of those patients were successfully placed in moldable skin barriers.  Not having to cut skin barriers helped to obtain a more secure fit, which decreased the chance of leakage and trauma to the stoma.  The hydrocolloid tape border on the moldable skin barrier has helped resolve irritation from acrylic sensitivities for some patients.

Conclusion: 

For optimal patient outcomes, WON’s need to do a comprehensive patient assessment.  Keeping current with the technology of skin barriers and pouching systems is essential as product upgrades are frequently developed.  For our patient population, moldable skin barriers* have improved our clinical outcomes such as wear-time and peristomal skin problems.  This product is better able to manage patient concerns related to leakage and/or skin irritation.