Tips for Easier Ileostomy Appliance Changes and Skin Care

Hi,



I'm a registered nurse that has just started working on  a general surgery unit. I don't have that much experience with changing ileostomy appliances. I had one patient the other night who's ileo appliance is always leaking. Sometimes her appliance is changed 1-3 times in a 24 hour periord. We use eaken to fill in any skin depression in order to increase the seal... The problem is that everytime we change her appliance I run into a lot of problem when trying to clean peristomal skin and removing the previous eaken. It sticks onto the skin like cement, particulary the last layers..During the last appliance change I couldn't even remove all the eaken as it was too painful for the patient.. Her peristomal skin is always irriated due to the constant leaking from the appliance. To remove the eaken I try to wet the area well with a damp 4  x 4 guaze, as well the remove wipes and I try to take off as much as I can with a tongue depressor.. I'm wondering if there is anything else I can do to make the process faster, easier and less painful for the patient. I spent nearly 45 min trying to remove all the eaken, and it wasn't even a lot. My patient is actually not eating right now...She's recieving TPN and lipids through a Picc line because she also has a cutaneous bowel fistula that also leaks green bile fluid not too far from her ileostomy stoma..So the fluid that she is putting out from her stoma is also just  bile fluid...so very irritating to the skin and more easily leaks.. I'm wondering if the mixture of the stoma ouput with the eaken makes the old eaken more difficult to remove.



Anyways... sorry for such the long explanation..I'm wondering if anyone has any advice on how to deal with such a challenge..



Thanks in advance.



Marianne

Hi Marianne, welcome, I don't know if this will help but I had tried the Eaken seals for a short while and seemed to have the same problems. I am using Hollister products and started using their Adapt seals and found they peeled off much easier. I also had times when I had to change up to six times a day until one of our great nurse ostimate told me not to use any skin prep, just the adhesive remover and use a soap without any oil and perfumes and it was a remarkable change, especially if you can get a almost perfect seal without any skin showing then when the flange is applied you don't have to worry about how centered you are, it shouldn't leak, hope this makes sense, lots of luck, Ed.



PS: about three posts down from yours there is a post Ileostomy Question at or near the bottom of the page that I did a while back, have a look, maybe something will be of help.

The Eakin Seal is made of a better material than the Hollister.  If there are remains of the Eakin Seal firmly adhered to the skin.  It is Ok to leave and put a new seal over it.  

what is important is there be no oil on the surfaces.



question:  If the Eakin Seal is Adhering well to the skin, why the leaks.  what are you not saying?



As I mentioned the Eakin Seal is made of  better material as far as resistance to intesinal enzyms.   However the Hollister may for this particular person work better.



There is no set rule.  It is all trial and error.  Usually the patient themselves have to get it figured out.  Sometimes it takes a few months to get it right.



After a few months in all probability the patient will be able to peel off the wafer in seconds.

Shave, clean and prep the stoma in a minute of two.  Install the new wafer, use a hair dryer with a little heat while the wafer is pressed against the skin.



If the patient is obese, or has skin folds where the wafer seals. It makes things a lot harder.



Good luck

Rick.....

Hi Marianne, how lovely that you have come to us for some advice - there have been several posts recently about nurses and here you are, showing that there are still some left who care, thank you!

Have you tried using one of the powders before using the eakin seal to protect the skin? I have been using Orahesive powder on a sore bit under my stoma now for some months and it is healing, albeit very slowly, and the seals do not stick to it, though think the output you are having will be pretty hard on the skin anyway .... Also the use of a hairdryer to dry stoma area before applying and once applied to warm the appliance to the skin does help a great deal too.

Good luck ... Rach xx

As Ostimates, you learn something new every day, fo example, Junopete says its not necxessary to remove all the liottle bits left sticking to the skin, sure wish I knew that before, but the question remains:



question:  If the Eakin Seal is Adhering well to the skin, why the leaks.  what are you not saying? Junopete



Does the patient have a good stoma, not too eliptical, and can the seal just barely touch the stoma, or, maybe if the patient is always laying on the back and the output is pooling and as pete says the enzymes are eating away at the seal and wafer?

Living with Your Ostomy | Hollister

Some good answers here so I thought I would ask one of my own fellow Ostimates:

when I put on my seal after warming it up a bit, I make sure the seal is about 1/32'' smaller than my stoma, ergo, nothing gets by that seal and it matters not how centered the flange is positioned. Question: does anybody else use this method: Ed

I know some nimble fingered ostimates can do this without using a jig, alas I`m not one of them.

Also would like to express kudos to Marianne for looking out for her patient, Bless you. Ed

hey and welcome...a tough question. the main good thing about the eakins are their "stickiness", they seem to dissolve over time and mine are still present after 7 days. did you try contacting the manufacturer?? i think the remover wipes are mainly intended for the glue on the edges of cloth base flanges. did you try convex flange to remedy the leak?? my suggestion would be a convex flange without eakin for a short time till the old residue naturally dissolves. i assume you are cleaning with correct unscented or oiled soap and using a skin prep wipe before the eakin. i would add that if you wet your fingers a bit before you handle the eakin it wont stick to you as badly. hope this helps

I use a convex flange and an Eakin seal and I find that the sooner I have to change the flange the more of the seal remains. I gently wash the area with a warm wet washcloth and Ivory soap which is a mild unscented soap. Sometime I need to just let the warm water repeatedly flood the area in the shower, but I think if your person cannot get into a shower you could continue to gently wipe the warm wet soapy cloth over the area it should work. The idea is to keep dissolving the seal with the wet warmth. Good luck.

Pat

Have nothing to add on the topic ... just wanted to say hi and welcome!



And thank you for showing me that there are still some nurses who care and ask questions and continually want to learn and don't think they know it all  (I know there must be LOTS of nurses like this, just haven't encountered too many myself

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Hope to see you here often.