Using Silicone-Based Products for Adjacent Mucous Fistula to Prevent Lifting Ostomy Appliance, MASD, and MARSI in Infants

Problem:

Infants who require diverting fecal ostomies frequently involve the creation of a mucous fistula in close proximity to the active stoma. This creates challenges in pouching the active stoma (jejunostomy, ileostomy, or colostomy) while also protecting the nearby mucous fistula. Traditional techniques can lead to skin damage that rapidly deteriorates unless the approach is modified.

Past Management:

The common use of petroleum-based products over the mucous fistula can lead to premature lifting of the adjacent ostomy appliance; this can in turn lead to Moisture-Associated Skin Damage(MASD) from ostomy effluent leakage. Lastly, it can contribute to Medical Adhesive-Related Skin Injury to skin around both stomas from the frequent appliance and dressing changes. Any/all of these issues can cause significant pain for the infant.

New Management:

One of two different silicone-based protective sheets is chosen to cover the stoma of the mucous fistula, and then silicone-based tape over this to keep the barrier secure. Parents and staff alike are taught the technique.

Results:

MASD, MARSI, or pre-mature leakage of the ostomy appliance are avoided using the silicone-based products instead. The desired effect of protecting and maintaining moisture to the mucous fistula has also been accomplished.

Conclusion:

Revising the approach to managing adjacent stomas (jejunostomy, ileostomy or colostomy with a mucous fistula) has resolved prior concerns of MASD, MARSI, and the added cost of multiple ostomy appliance changes d/t the wafer being lifted by petroleum products used on the mucous fistula. The slightly greater expense of the silicone-based products is easily off-set by the decreased incidence of premature pouch leakage, skin irritation, and the associated pain endured by the infant’s from eroded skin.