Operation Stoma #Wall It Off

Patients with ostomies often have significant issues with effluent containment and leakage generally related to improper appliance application.  This situation is particularly difficult and challenging when there is an incision or open wound in close proximity to the stoma.  It is essential for the appliance to be attached correctly to facilitate skin protection, prevent leakage and optimize peristomal wound healing.

Several factors are considered when developing a plan:  the characteristics of the stoma, the proximity and type of wound near the stoma, type of effluent, abdominal contours and the ability of the patient and their caregivers to duplicate the appliance application.  Our past management using traditional methods was too prescribed, not individualized and ineffective. The three case studies presented demonstrate that the patient’s best interests are served when a customized approach is developed, utilized, and careful consideration is given to the patient’s psychological as well as physical comfort.  We found that an individualized and resourceful approach must be developed in order to best serve the patient’s specific situation.  One of our effective methods included using step-by-step photos for teaching and replication purposes used by surgical staff, nursing staff, patients and caregivers in the inpatient as well as the outpatient setting. Using a variety of techniques, creative approaches, and ostomy and wound management guidelines, these case studies offer unique problem-solving methods and successful patient outcomes.

“Walling off the stoma” allowed these patients to experience increased appliance wear-time, decreased caregiver maintenance time and frustration, decreased supply costs, reduced leakage, more effective odor control and improved skin maintenance thereby promoting peristomal wound healing.  It was anecdotally reported by patients, families and bedside clinicians that there was enhanced patient satisfaction and quality of life as a direct result of this approach.  We now use this approach with such cases due to the demonstrated success.