Archive for the ‘ostomy management’ Category

Learn tips for proper colostomy irrigation

Tuesday, September 3rd, 2019
colostomy irrigation

Wild on Wounds speaker Anita Prinz, RN, MSN, CWOCN, shared pointers in September at our national conference on colostomy irrigation as a life-changing ostomy management alternative to pouching.

One of the most important and rewarding aspects of working with ostomy patients is helping them adapt to life with a stoma.

A supportive and caring healthcare provider can make all the difference, educating patients on the best ostomy management practices for their schedule and lifestyle.

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One patient’s perspective on how to adapt to living with an ostomy bag

Tuesday, August 27th, 2019
living with an ostomy bag

Collin Jarvis was 21, athletic and a captain of his university’s track and cross-country teams.

He was about to enter his senior year at the University of California, Berkeley when he was diagnosed with ulcerative colitis.

Only eight months later, in March 2014, Jarvis’ condition unexpectedly worsened and he had to undergo an emergency colectomy.

Jarvis said he never expected to develop complications from his illness so soon. After his surgery, he found himself living a totally different life than he ever imagined — as a person with an ileostomy.

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Instructor named 2019 WOC Nurse of the Year for ostomy care

Tuesday, June 25th, 2019

ostomy care

On June 23, alumni of the Wound Care Education Institute (WCEI) cheered to see a dedicated clinician, teacher and nursing entrepreneur receive recognition for her commitment to ostomy care and education.

By Keisha Smith, MA, CWCMS

The United Ostomy Association of America named WCEI Clinical Instructor Joy Hooper, RN, BSN, CWOCN, OMS, WCC, its WOC Nurse of the Year.

The prestigious award shines a spotlight on the many ways Hooper has touched lives with her commitment to teaching ostomy care.

“My father has always taught us the importance of helping people, and one of the most important people to help is the one you’re not expecting a thank you from or expecting anybody to know about,” Hooper said. “That is someone who you want to help. You won’t see this immediate reward, but you will be rewarded. UOAA and helping people have always been close to my heart.”

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Home health nurse shares wound care certification journey

Wednesday, April 10th, 2019

wound care certification

What does it mean to be a leader in wound care? It’s about being a credible resource for care decisions based on the evidence, which wound care certification achieves.

By Keisha Smith, MA, CWCMS

It’s about focusing on what you can do, big or small, to make things better for your patients, team and organization.

Every day, thousands of our Wound Care Education Institute (WCEI) alumni lead in this way with wound care certification.

If you participate in our alumni-only Facebook Group called “Wound Care Rocks,” you might recognize Trisha Dubois, RN, WCC, OMS, as a clinician who demonstrates those leadership qualities. She’s eager to learn from other certified clinicians in our group.

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Ostomy Minute: How to Get a Good Seal Without Skin Residue

Friday, March 30th, 2018

How can you create a good seal under the skin barrier of an ostomy appliance without leaving residue on the skin? In this one-minute video, WCEI Instructor Joy Hooper, RN, BSN, CWOCN, OMS, WCC discusses new products you should explore.

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Ostomy Minute: Is Ostomy Paste an Adhesive?

Sunday, February 18th, 2018

When you need extra adhesion under a skin barrier, is ostomy paste the way to go? WCEI instructor Joy Hooper sets the story straight in this short video.

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Stomas: What You Need to Know

Friday, January 6th, 2017

There are two main types of stomas, and they both have certain “ideal” characteristics in common. Do you know what they are?

Stomas: What You Need to Know

 

You say potato, I say potahto. You say ostomy, I say … stoma. Huh? Those of us in wound care know that it’s not uncommon to hear the terms ostomy and stoma used interchangeably, even though they have different meanings.

In the WCEI blog, “Let’s Talk Ostomy Types,” we described the types and sub-types of bowel and bladder ostomy surgeries. Now, we’re focusing on an aspect of ostomies that wound care professionals experience directly in practice: the stoma.

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10 Most Common Ostomy Patient Questions

Wednesday, August 17th, 2016

Ostomy Lifestyle Specialist and fellow ostomate Laura Cox shares her most frequently asked patient questions (and she gives you the answers, too).

Ten Most Common Ostomy Patient Questions

photo: Sherry Yates Young/Shutterstock.com

Editor’s note: in her blog series, Ostomy Lifestyle Specialist Laura Cox, Shield HeatlhCare, shares lifestyle tips and information with fellow ostomates. After being diagnosed with Ulcerative Colitis at the age of eighteen, Cox underwent ileostomy surgery in 2011. Today, you can find her one-on-one advice, support and insights at her OstomyLife blog, and on other Shield HealthCare social media sites.

 

In my experience working with a variety of healthcare professionals and patients, I continuously field a variety of questions about ostomies, some of which I hear again and again. And I’m always happy to answer them.

For clinicians working with ostomy surgery patients, it’s important to be armed with helpful information that can be shared in order to help them learn to be more comfortable and confident after surgery. That’s why I’ve compiled the ten most common questions that ostomy patients ask – along with my answers from personal experience. By sharing them within your facility, you can help your patients feel more confident as they heal and regain their independence.

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Let’s Talk Ostomy Types

Thursday, June 16th, 2016

(Adapted from About Ostomies: Ostomy 101 by Shield Healthcare)

A comprehensive guide to the different types of ostomies, including colostomies, ileostomies, and urostomies.

Ostomy Types

Do you know your ostomy types? There are three kinds of bowel or bladder ostomies, and with this handy guide, you can brush up on each one – including the multiple sub-types. But first, let’s cover the basics.

Ostomy Surgery

Ostomy surgery is a surgical operation that redirects body wastes through a new outside opening, called a stoma. The stoma is a new exit point created to divert feces or urine. In some cases, multiple stomas are created to divert both. The term “ostomy” is used interchangeably by patients to refer to their medical condition, their stoma, and/or the appliance used to collect waste.

Intestinal ostomies are most often performed in conjunction with: tumor removal; to permit repair of bowel injuries; congenital defects; or as a last resort, treatment in medically unmanageable cases of inflammatory bowel diseases. Indications for urinary diversion include: tumor removal; congenital or nerve defects; or injuries that take away voluntary bladder control.

Types of Ostomies

There are three types of bowel or bladder ostomies, along with multiple sub-types:

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It’s Complicated! Ostomy Patients and Peristomal Skin

Friday, March 18th, 2016

This overview details the five main categories of peristomal skin complications that wound specialists commonly treat in ostomy patients.

Peristomal Skin Complications

If you’ve worked with ostomy patients for any length of time, you know that maintaining a proper seal can be difficult once the peristomal skin (the skin surrounding a stoma) has been compromised. The resulting complications can drastically reduce an ostomy patient’s quality of life, and lead to social isolation, anxiety, and depression. Additionally, when patients need to change their pouches multiple times per day, it also poses a tremendous financial burden.

Unfortunately, ostomy patients with peristomal skin complications often don’t even recognize that complications they are experiencing are treatable. They simply accept it as part of their new life with a stoma, and forgo seeking help. The good news is that we are in the position to not only learn more about peristomal skin complications, but also help educate our patients so that when they suffer from complications, they know there are solutions.

The Basics

Peristomal skin complications usually fall into one of five categories:

  • mechanical trauma
  • infection
  • chemicals and irritants
  • diseases
  • skin allergens

Of all ostomy patients, ileostomy patients have the most complications. That’s because the output from their stomas (the effluent) is watery and caustic. In fact, peristomal skin complications have been estimated to be as high as 57% for patients with ileostomies, 48% with ileal conduits (from urostomies), and 35% with colostomies.  Incidentally, the rate of complications in colostomy patients is lower because it’s easier to contain stool, which is more solid.

So let’s get specific and take a closer look at each type of peristomal skin complications.

Mechanical Peristomal Skin Trauma

Mechanical trauma results from pressure, friction, or shear. Pressure can result from an ill-fitting ostomy appliance, ostomy belt or convex pouching system. Friction occurs from abrasive cleansing, improper pouching removal techniques, and frequent appliance changes.  The tissue damage can be partial to full thickness.

Peristomal Skin Infections

Peristomal skin is prone to infection from bacteria and fungi.  Two common peristomal infections are candidiasis and folliculitis.

Peristomal Candidiasis

Peristomal Candidiasis

Peristomal Candidiasis – This type of infection is an overgrowth of the fungus Candida Albicans surrounding a fecal or urinary diversion.  Fungi thrive in warmth, moisture and darkness.  So when an ostomy patient experiences perspiration, pouch leakage, denuded skin or prolonged wear time, moisture is added beneath the skin barrier.

Of course, this can provide the perfect environment for fungi to grow.  In addition, some patients are simply more predisposed to peristomal candidiasis because of various conditions such as immunosuppression, diabetes, or antibiotic therapy. Such infections can be found anywhere on peristomal skin, but is most commonly found under the skin barrier or under the pouch where it touches the abdomen.

Folliculitis – This is inflammation and/or infection of superficial hair follicles, resulting in isolated lesions or discoloration right at the follicle site.  It can be caused by chemical irritation, such as the effluent, or physical injury, such as rough shaving of the peristomal skin, ripping off the skin barrier, or friction of hair follicles under the skin barrier.   Staphylococcus aureus, streptococci, and pseudomonas aeruginosa are the most common bacteria found with folliculitis.  As with candidiasis, patients with diabetes, immunosuppression or antibiotic therapy are more likely to develop this infection.

Chemicals Irritants

Peristomal Irritant Contact Dermatitis – Following ostomy surgery, as many as 50% of patients experience peristomal irritant contact dermatitis, which is an inflammatory reaction to a chemical that results in well-defined erythema, edema, or loss of epidermis.  Papules and vesicles are often present as well.  You may know this condition as peristomal moisture associated dermatitis (as discussed in the WCEI blog, MASD: Know Your Types). The chemical irritant can be soap, solvents, or adhesives, but it is often the patient’s own effluent leaking from a poorly fitting pouch or seal. It’s especially prevalent in ileostomy patients because their stoma output is watery and caustic.

Hyperplasia

Hyperplasia

Hyperplasia – This condition is known by many names: pseudoverrucous lesions; chronic papillomatous dermatitis; hyperkeratosis; granulomas;  pseudo-epithelial hyperplasia; exuberant tissue growth; and proud flesh. It’s the result of prolonged skin exposure to urine and moisture. Typical causes include:

  • a pouch that is cut too large for the stoma
  • patients with high output liquid stool
  • urostomy patients, if the skin is in contact with alkaline urine
  • a stoma that is flush with surrounding skin or retracted

Hyperplasia presents as patches of discolored, thickened epidermis and papules, nodules, or both.

Alkaline encrustations – In your urostomy patients, you may find crystal-like formations on exposed peristomal skin. These crystals are called alkaline encrustations. When you remove the pouching system, the skin may bleed. This condition is associated with hyperplasia (discussed above), alkaline urine and/or concentrated urine that pools on the peristomal skin, renal calculi or kidney stones, and urinary tract infections.

Disease of Peristomal Skin

Pyodermal Gangrenosum

Pyodermal Gangrenosum

Pre-existing skin diseases such as psoriasis, eczema, or seborrheic dermatitis can cause issues in the skin surrounding the stoma.  But sometimes more serious conditions can develop, such as pyoderma gangrenosum (PG), which is an inflammatory, ulcerative autoimmune disease condition. PG begins as pustules and continues to extremely painful ulcers that may become full-thickness and excavate under the skin. Even though it occurs in 50% of ostomy patients with underlying inflammatory bowel diseases (such as Crohn’s disease and ulcerative colitis), the etiology of peristomal pyoderma gangrenosum remains unknown.

Peristomal Skin Allergens

Peristomal Allergic Contact Dermatitis – Contact skin allergies are fairly common in the population, so it’s not surprising to find that some ostomy patients have allergic reactions to pouching systems, accessories or skin care products. Many patients develop a peristomal contact allergy only after repeated exposure to the offending product, or if they are sensitized to a related cross-reacting substance. Allergic reactions typically include erythema along with itching, papules, vesicles, discoloration, crusting, oozing, or dryness.

Suture Granulomas – Suture granulomas are granulation tissue at the suture skin interface and are a reaction to suture material. These present as scattered, red areas of friable granulation tissue where sutures are present.

Simply Put

Peristomal skin complications not only prevent proper pouching, they undermine the comfort and well-being of our patients. And as always, our mission is to help patients heal and enjoy a higher quality of life whenever possible. By understanding the different types of complications and combining treatment with patient education, we can fulfill that mission tenfold.

To learn more about peristomal skin complications (and earn an education credit while you’re at it), view the WCEI webinar, “Troubleshooting Peristomal Skin Complications.” You’ll find out more specifics about this topic, including clinical characteristics and treatment plans.

What do you think?

Were you already familiar with the five common types of peristomal skin complications? And do you have any particularly challenging cases that relate to ostomy patients and one of these types of complications? We would enjoy hearing all about your clinical experiences regarding this topic. Leave your comments or questions below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.