Seal the Deal: Managing Full Thickness Wounds Around a Stoma

Problem Statement:  Full thickness wounds in close proximity to stomas on patients ranging from neonates to elderly adults present on-going challenges for healthcare providers, caregivers and patients. Containment of effluent, optimization of peristomal wound healing, and protection of the surrounding skin is essential when caring for these patients.   Without proper management of the wound and the stoma, quality of life, pain management, physical activity, caregiver time and supply costs are negatively affected. A need for an individualized, effective wound management plan was identified.

Management:  Prior to CWOCN involvement, patients in these case studies were managed with wound dressings, barrier creams, and pouching systems. Wound dressings and barrier creams required frequent changes by healthcare providers and were largely ineffective.  This resulted in an increased workload for care providers and overall patient dissatisfaction.  The pouching systems failed to maintain an effective seal, and leakage led to increased odor and further skin breakdown.

Clinical Approach: An individualized plan of care was developed for each patient which included frequent rounding by the CWOCN, picture instructions and bedside in-servicing for staff and caregivers.  The management plan was based on the proximity of the wound to the stoma, the ability of providers to duplicate the care, patient comfort, and the effectiveness of the seal.  The case studies described demonstrate a variety of patient interventions where individualized, creative pouching solutions promoted full-thickness wound healing.  The result was improved care provider satisfaction and patient quality of life.

Outcomes:  Patients discharged were transitioned from a high-level of  CWOCN involvement to routine ostomy and wound care provided by staff or family members.  Written and picture instructions improved communication between CWOCNs, nursing staff and family members.

Conclusions:  Individualized, resourceful care that utilized basic wound healing principles, combined with effective communication, resulted in improved patient wound management and effectiveness of the pouching seal.