Best Ostomy Options for Quadriplegic Care

Hello Friends,

My dad, who is quadriplegic, arrived home from the hospital after an ostomy surgery today. The ostomy nurse sent us home with 10 pouches that require us to squeeze the contents out of the bottom. It needs to be done about four times a day, which makes it difficult for my mom to be able to do other tasks or recreational, self-care activities. My mom is his primary caregiver, but I also help support her.

I'm trying my best to help them stay at home, as independent as possible, and not end up in a facility. We are overwhelmed with all of the pouch systems options out there and very new to this. All the models and videos that we see are for folks who can empty the bags themselves. Quadriplegic people don't have the use of their arms or even fingers. Can anyone suggest a system that a caregiver can use for another person with as little mess and leakage as possible? Ideally, the fewer the changes the better, and a disposable system would be great. Any suggestions would be much appreciated! I don't know what else to ask because I'm so ignorant. Thank you for this forum. Happy holidays and well wishes to all.

 

Does he have an ileostomy or colostomy? Is his ostomy equipment a separate wafer and bag (a 2-piece system), or one piece (wafer and bag together)?

It is hard at first discovering what equipment works best. Answers to the above questions will help us to provide proper advice.

Oh my. That's a tough question. Bless you for helping. I'm perplexed. Someone will help though. You are not ignorant. Stop that. You and your mom are angels, with a difficult task at hand.

Sit tight. Answers forthwith.

Peace and blessings to you and yours.

Under the circumstances, you might be better off with a 2-piece system and a closed end pouch. This would allow your mom to remove a full pouch and replace it with a new one. 

Normally a closed end pouch is only used by people with colostomies but it may be worthwhile to use it regardless of the type of ostomy in your unique circumstances.  

Some explanations since you sound new to this:

A 2-piece system consists of a flange that attaches to the skin and a bag that snaps into the flange like Tupperware. It is easy to take a bag off, discard it and replace with a new bag. The flange stays in place for 3-4 days. 

I believe Medicare will pay for 90 closed end bags per month (please verify, I am not on Medicare so I am not 100%). If you need 4 bags a day, this choice will incur some out of pocket costs. 

Do you have an ostomy nurse who can help you learn to do a full replacement (flange and bag)? We can help troubleshoot but there's nothing like some in person advice. 

Helpful tip: you can call ostomy suppliers and get free samples to try different brands. The 3 major brands are Hollister, Coloplast, and Convatec. Selection of a system is really very personal. The ostomy nurse would be most helpful here. 

PS keep asking questions as they occur to you. There are lots of great and knowledgeable people here.

Living with Your Ostomy | Hollister

@susan..off topic here..from another you replied to saying you wondered why you weren't rich.

Honey, you are rich being articulate, direct, professional.

A good egg. You nailed this answer. This is me patting you on your back 👋. Good reply.

I think a drainable bag would be best. Use a baby potty to collect waste and a water squirt bottle to rinse the bag. Just my thought.

Hmm, I do this. Drain into a handheld container while standing up. Dump into the toilet.

Not sure if it works in a sit-down position. Also, better not miss that container. Backsplash is an issue too if there's high output. And the smell. Using M9 would help regardless of the bag type. M9 or cheaper smell killers are available.

Disposing of a sealed bag sounds quicker, easier, and less messy.

Just my two cents' worth.

They need to get free samples and experience what works best. Good topic. Good reply. Getting our buzz on as a group to help them out any way we can in their difficult, unique situation.

This is helpful. Love. Understanding. Spirit of the season. Even though we as a group offer it every day.

Great peeps here. All ❤️ heart.

Just an added note or two regarding two-piece systems and that flange. There is an O-ring under that flange. I use this system. It works with an O-ring (barrier ring) or not. However, over time, like Susan said, you can get 3-4 days' wear out of this flange. I'm getting close to 8 days, though. My skin caused leaks. That's another topic. But yes, I lean toward two-piece disposable bags I would suggest. There is a neat round C-clip design that holds the bag to the flange. It's tough getting it on. A "snap" or click is a positive result. I find it bulletproof setting it all up first then placing it over his stoma. But this works for me. There will be some confusion over the terms.

Flange = mounting plate. For example, Susan noted that.

You're in the right place, hon. We've got your dad's back. Um, front I mean 👍

Empty it four times a day, I'd say use a closed bag. Take one off, throw it away, and snap another one on. Someone will just have to monitor it throughout the day to change it before overfilling. That would be the easiest, but you'll go through a lot of bags. And if someone is there to monitor the bag filling, you'll go through a lot fewer bags by having a drainable bag and just emptying it. Or, you could do a combination of both. No matter what you use, someone will have to monitor it periodically throughout the day.

I have been doing the combo for a few months. Until I run out of the closed bags.

Today I switched to my Hollister 2 piece closed bags because I forgot to punch holes in a new box of Coloplast wafers.

Speaking of, I haven't heard others using a hole punch yet here. I've only been hearing folks using scissors. I invested in 2 sizes so far.

I believe a hole punch is only good on 2 piece systems so a lot of us couldn’t use them. Plus, using a hole punch limits a person to that specific size unlike scissors where you can cut the hole however you need to as things change. 

Since you are new to this, you may not need to change the pouch 4 times a day. When you are squeezing out the contents you tend to do it more frequently. It seems, based on frequency, that he has a colostomy. Also, gas can make the bag appear full. When I left the hospital, I was told to empty the pouch when it was 1/4 full. I have a colostomy and use closed end pouches with a 2-piece system. I change the pouch when it is 1/2 - 3/4 full — normally 3/4 full, 2 - 3 times per day. Since your dad is immobile, an adhesively coupled 2-piece system should work fine for him:

Convatec: https://www.convatec.com/products/ostomy-care/surgery-type/ostomy-colostomy/esteem-synergy-adhesive-coupling-technology-stomahesive-skin-barrier/

Adhesive Coupling makes snap on/off easy — try free sample. I think Hollister sells one too but not Coloplast.

I have never tried an adhesive system like that but it may work beautifully for the OP. 

Good point also about possibly needing to change bags less frequently than you'd squeeze out waste.