�Make sure your peristomal skin is clean and dry before applying the pouch. It is not necessary to use sterile supplies.
�Hold a warm hand over the pouch and stoma for 30 to 60 seconds after application to warm it and assure a good initial seal. Never warm pouches in a microwave oven. (Yes, it happened!)
� Make sure the skin around the stoma has no skin folds or wrinkles when applying the pouch. These wrinkles may cause the seal to break when you do straighten up or lie down.
�Don't peel your pouch away from your body. Take hold of the edge of the adhesive sections of the tape and push the skin away from the tape or use adhesive remover.
�If you are using paper tape as a picture frame around the faceplate, dampen it with a little warm water after it is in place. It will stick much better.
�Wear protection (a pouch cover) between the pouch and your skin to a prevent rash from perspiration. There is also a line of underwear for ostomates that has a panel between pouch and body. Quick fix: Stick a panty shield (feminine hygiene product) on the back of your pouch.
�If you use scissors to cut your face plate openings, don't keep them with your pouches unless there is a case for them. The sharp points could puncture your pouches.
�Store pouches away from warm, humid places. "Meltout" can render equipment ineffective. Insulated lunch bags are good for storage of emergency supplies for car or office.
�Keep air in your pouch so that there is not a vacuum effect of the pouch onto the stoma.
�Spray the inside of your pouch with PAM� to help the contents keep sliding down the pouch.
�Wear your pouch inside your underwear for support.
�Keep a list of equipment, complete with order numbers, sizes and manufacturers. Let a member of your family know where you keep the list so they can get the necessary supplies in the event of an emergency.
�If being admitted to hospital, take your application procedure and supplies with you. The hospital may not stock the supplies you use. Do not expect staff to change your pouch if you are able to do so.
�Clean pouches in cold water. That decreases absorption of odor and discoloration into the plastic of pouches.
Skin Irritation
� Skin irritation is usually caused by an improperly fitting pouching system, poor adhesion, or irritation from the adhesive. Watch for sensitivities and allergies to adhesive, skin barrier, tape, soap residue or pouch material.
�Remeasure your stoma to ensure the correct size of pouch and skin barrier opening.
�Change the pouch regularly, Many times the skin irritation will clear up under the pouch but prolonged wearing then causes the skin to break down again.
�Do not "rip" the pouch away from the abdomen or remove it too frequently. Remove it gently by pushing your skin from the pouch rather than pulling the pouch from the skin. Water will often help.
Skin Barriers
�Karaya base barriers are appropriate for sigmoid and descending colostomies. They tend to dissolve rapidly in watery fecal output and urine output.
�Pectin and synthetic base barriers (e.g. Stomahesive� and Premium wafers and rings) are very resistant to fecal output but most melt with urine. As a result, a new line of solid barrier wafers has been developed; these barriers are resistant to urine and are also more resistant to liquid fecal drainage. This category of barriers is commonly called "extended wear" (because they hold up for a longer period of time) and include products such as Durahesive� and Flextend�.
�Liquid skin protectors (also known as skin "sealants") provide a plasticizing film over the skin that protects the skin from moisture and from tape damage. This category of products includes Skin Prep, Skin Gel, etc. Skin sealants, protective skin wipes and barrier pastes contain alcohol so they will sting when applied to irritated skin.
�Treat minor skin irritations with Stomahesive� Protective Powder or Karaya Powder. Sprinkle lightly on the skin, blot over powder with skin sealant, and allow to dry before applying pouch.
�If you cut your own center holes, save the leftover pieces and use them to fill in any skin indentations around the stoma underneath the wafer.
�Skin barrier paste is used to "caulk" around the stoma or to fill in uneven skin surfaces. Not everyone needs to use it. Those with loose stool will find it most beneficial. It may also prolong pouch wearing time for urostomates.
Stomas
�Spot bleeding often occurs during cleaning and pouch changing. This is common to all ostomates. Prolonged bleeding, increased amounts of bleeding, or very easy bleeding may indicate another problem and should be reported to your doctor.
�Edema of the stoma is normal up to 8 to 12 weeks post-op.
� Swelling of the stoma occurs with food blockage or improper fitting pouch. If allowing more room between the stoma and the faceplate does not reduce the swelling, it is time to have an examination by either a nurse or your physician.
�Rather than risking further damage by trying to remove the pouch by pulling it over the swollen stoma, try cold compresses or an ice pack over the pouch to reduce the swelling. Then ease the pouch off carefully. Replace it with a pouch with a larger opening until the swelling has subsided.
�Bathe or shower with or without your pouch. Soap cannot harm the stoma. Just rinse well. Do not use an oily soap around the stoma.
�Do not use "baby wipes" to clean skin around the stoma. Most contain lanolin that leaves a residue on the skin that interferes with adhesion of the pouch.
�If you bathe with your pouch off, hold a cool wash cloth over the area to close the pores of the skin. Then pat dry and apply the pouch. Sometimes the heat from a hot bath or shower will keep the skin warm and will generate moisture under the barrier and prevent a secure seal.
�Stomas have no sensation. It is the skin that senses the pain, not the stoma. For this reason, it is important not to wear your pouch for a long period of time since it is good to periodically check the stoma. Normal pouch wear time is 5 to 7 days.
�Don't allow anything to be put into your stoma without your doctor's personal supervision. Question any procedure that intrudes upon the stoma, including suppositories.
�The normal color of the stoma is pink-red. If the stoma becomes dark, see your ET nurse or your physician.
*This information is from UOA's HELPFUL HINTS (August 2000) compiled from several sources including chapter newsletters, UOA Care Guides, and healthcare providers. Several WOC (ET) nurses have reviewed the information for its accuracy and benefits. Always consult a physician or WOC (ET) nurse before altering any recommended routine.
via The Mission Ostomy Chpt. of Tucson (AZ) THE COURIER October 2000
Los Angeles Times Syndicate