Actually, now we are on the subject, I'll just go ahead and post all I have on taking extra care to prevent further trauma to the peristomal skin. Here are a few tips on how to best achieve this, directly from a colorectal surgeon that specializes in pediatrics. Hope it is of use to all with peristomal skin problems.
When an ostomy appliance needs to be replaced, care must be taken to avoid damaging the peristomal skin during pouch removal. A soft cloth dampened with warm water should be used to loosen the barrier adhesive. Soap, which contains surfactants, may be helpful to decrease the amount of friction required to remove a particularly adherent barrier from the skin without trauma. The soiled pouch should be removed by gently pushing down on the skin to separate it from the wafer while lifting up on the pouch.
Adhesive removers, often used to minimize traumatic pouch removal, should not be used.
Skin reactions consistent with chemical breakdown occur after exposure to petroleum distillates, an ingredient contained in adhesive removers.
Furthermore, adhesive removers contain alcohol, which is well documented as causing topical and systemic effects including skin blistering, burns, and ulcers.
Use of adhesive remover should be limited to situations in which adhesives are so bonded to the skin that it cannot be removed without risking damage to the fragile epidermis.
After application, the skin should be thoroughly washed and rinsed to remove any chemical residue. Pectin remaining on the skin after pouch removal should not interfere with pouch adherence and unless you are allergic to pectin, is not damaging to the skin, so it need not be vigorously removed.
Peristomal skin should be gently cleansed with water between pouch applications. The use of soap is discouraged because any residue left under the barrier could cause chemical dermatitis. If soap is used, it should be a pH-neutral soap without antibacterial or deodorant additives and it should be thoroughly rinsed from the skin before pouch reapplication.
Alkaline soaps may disrupt the acid mantle of the skin for up to 7 days, thereby crippling an important barrier to infection. Soaps containing moisturizers should be avoided because they will interfere with pouch adherence.
Commercial infant wipes are lanolin-based and most contain alcohol, and thus they are not suitable for cleansing peristomal skin.
Skin barrier wipes or skin sealants are plasticizing agents applied to the skin to create a barrier. They can protect skin from the corrosive effect of stool and are used effectively.
Skin sealants are sometimes used by ostomates to protect peristomal skin from epidermal stripping, which may occur during pouch removal.
Currently, the only alcohol-free skin sealant on the market is Cavilon No Sting Barrier Film sold by 3M. This product consists of hexamethyldisiloxane, acrylate copolymer, and polyphenylmethylsiloxane. (I think WHOA suggested another no-sting product also)
Cavilon as a protective barrier beneath transparent semipermeable adhesive dressings used to secure intravenous cannulations on newborns showed a significant decrease in epidermal stripping without adverse effect on skin integrity after removal of the dressing and barrier film.
If a barrier wipe must be used, only an alcohol-free sealant should be used and it should be allowed to dry thoroughly to allow any chemical component to evaporate before pouch application. The addition of a supplemental barrier under the flange may improve wear time.
Several pectin-based moldable barriers and caulking strips are available that are able to withstand exposure to corrosive effluent. They can be shaped and trimmed to fit around any stoma for added protection against tunneling of effluent under the pouch.
Karaya should never be used because it releases acetic acid when it comes in contact with moisture and may burn the skin.
Use of adhesive is discouraged if you have peristomal skin problems to prevent epidermal stripping with removal. Generally, the pectin will bond with the skin and maintain an adequate pouch seal. However, a pouch incorporating a gentle adhesive tape around the flange may prolong pouch life if the edges of the skin barrier loosen with continued exposure to moisture.
Pouching systems in which the hydrocolloid barrier is available separate from the pouch but does not include a plastic flange greatly reduce trauma due to fewer changes of the flange.
Hydrocolloid skin barriers are flexible and will melt and mold around the stoma without causing damage provided the opening is not smaller than the stoma. A finger should be run around the cut edge of the barrier to smooth the rough edges before pouch application.
Uneven skin surfaces caused by incisions, skin creases, and other obstacles should be leveled before pouch application. A peristomal surface that is flat will provide the most effective pouching surface.
Skin barrier pastes are used to protect peristomal skin from effluent and to create a level pouching surface, they should be avoided because of their alcohol content. They may also contain formaldehyde, although in quantities small enough to avoid being listed in the ingredients.
A noncommercial, alcohol-free paste can be created by mixing skin barrier powder and glycerin.
The ingredients are mixed in proportions to achieve the consistency of toothpaste and then applied with a syringe. Without alcohol as a preservative, however, this mixture will quickly harden. Small amounts should be mixed for one-time use only.
When other options fail and commercial paste is required to keep a pouch in place, a low-alcohol paste should be used. Paste should be applied to the barrier with a syringe to minimize the amount used, and it should be applied only in areas where adhesion is most problematic. The paste should be allowed to air out at least 1 minute to maximize evaporation of the alcohol before pouch application.
Any skin barrier paste, however, including noncommercial paste, should be used with caution. The bond created between the skin and the pouch may be greater than the bond between the skin layers and may strip the epidermis when removed. Paste should be used only when other options to increase pouch wear time have been exhausted.
Fungal infections, which can proliferate in the warm, moist environment beneath the barrier and erode the skin, can be treated with nystatin powder applied to the involved area, with excess being gently brushed away before pouching. Alternatively, the powder can be mixed with water, painted over the involved area, and allowed to dry before reapplying the pouch.
To ensure dryness of the peristomal skin before pouch application, a skin barrier powder can be applied to weepy areas prior to pouching to absorb moisture and protect the peristomal skin. Skin barrier powders are alcohol-free and safe to use.
When applying skin barrier powder, only the minimum amount of powder needed to seal the eroded area of skin should be used, and excess powder should be gently wiped away. If the use of antifungal or skin barrier powders limits pouch adhesion, they can be sealed by patting the powder with a damp finger and allowing the area to dry. Any areas continuing to weep should be retreated with barrier powder in like manner until the weepage is contained.
Pouch adhesion may be limited by liquid effluent pooling around the stoma and degrading the barrier. This situation is especially problematic with ileostomies.
Measures should be taken to wick the liquid stool away from the stoma. Gel crystals that absorb liquid several times their weight, similar to the product in disposable diapers, are commercially available and can be used in pouches. An easy, inexpensive, noncommercial method of wicking away liquid effluent is to place cotton balls within the pouch.
After leveling the pouching surface, ensuring that the peristomal skin is completely dry, and applying the pouch, the barrier should be warmed. This can be accomplished by placing a hand over the barrier for 1 or 2 minutes after pouch application.
The importance of this step should not be minimized. Warming the barrier allows it to mold to the contours of the abdomen and increases adhesion of the barrier to the skin, improving wear time. Heating the barrier under a hairdryer is discouraged because the amount of heat absorbed into the wafer is not controllable and an overheated barrier can easily burn fragile skin.
It is always preferable to pouch a stoma to protect the peristomal skin from injury, particularly with an ileostomy. Sometimes, though, despite the best pouching system, pouches will not adhere to the abdomen. The peristomal skin must be protected from effluent by an occlusive barrier ointment such as petrolatum or zinc oxide. If the skin is denuded and oozing, however, these products will not adhere.
A skin barrier powder can be applied to denuded areas, followed by liberal application of a protective ointment. Alternatively, the powder and ointment can be mixed together and applied to the excoriated skin. Barrier ointments are available that will adhere to severely denuded skin and may be helpful to protect the skin from caustic effluent.
The ointment does not need to be removed from the skin, routine removal may traumatize the skin. Covering the ointment with a layer of petrolatum or petroleum-impregnated gauze will allow easy cleaning of effluent from the skin without removing the protective barrier ointment.
Finally, fluffed gau