Applying stoma paste - how much is enough?

Hi all, I want to try out my stoma paste for the first time instead of using the barrier ring but I'm not sure how much to use. Several have said to make a ring of it around the stoma, but how thick of a ring? I'm thinking less may be more and using too much might not be good, so I will wait and hope someone out there can give me some advice. Many thanks!

Terry

Hi, Terry.

I have used stoma paste with my appliance since day one.

When I was taught how to change out my appliance, I was shown to squeeze the paste directly from the tube onto the appliance's flat surface, along the cut edge that will set around the stoma, not to squeeze the paste directly onto the skin. Better control and no need for a mirror to see what you're doing on the "far side" of the stoma.

Dispense a flat bead of paste 2-3 mm thick around the entire appliance opening, and just as wide as the outside diameter of the tube's screwtop opening.

Position your appliance's opening above your stoma, then set it into place. Try to get it in the proper position the first time as it's difficult to move it once in place, and if you have to take the appliance off right after positioning - or in the next few hours - the paste will still be a gooey mess, and not easy to remove from your skin or the appliance. A waste of time, materials.

Once in place, gently run your finger (from the outside of the pouch) over and around the cut edge of the appliance around your stoma, to press the paste into crevices and help create a leak-proof seal between skin, paste, and appliance.

You may have paste ooze up a bit into the bag and adhere to the interior of the bag's surface. Just pull the bag away from the appliance backing - very slowly, gently, as you don't want to pull any more paste out than necessary and create a breach. Moisten the bag's interior surface close to the paste using the moisture from your stoma. The paste will have less of a tendency to stick to the moistened surface. Double the bag together with finger thumb where the paste is and rub as much of the glob of paste as possible off the bag's surface and let it drop down into the bag to be emptied with your output.

Help "set up" the paste by lying beneath a heating pad - set on medium or high - for about an hour before getting up and doing anything requiring abdominal muscle work...bending, flexing, etc. I find that I need the time to set up the paste so the appliance is less prone to pulling away from the skin/stoma, creating a breach. Not everyone has this kind of time, but I schedule for it.

I hope this helps, Terry.

Lily17

Thank you Lily for this very useful guide to using stoma paste. I could have done with you as my tutor many years ago when I first tried using it and got myself into an almighty mess. I have never used it since.

Best wishes

Bill

Hi Lily,   This is a big help, thanks so much.   How many days do you get between changes?   And are you using a flat or convex wafer?   I want to experiment a bit to see what works best for me.   I've been using the two-piece Hollister with a barrier ring which has been giving me four days, meaning change day, then four days without changing and change again on day five.   I feel like this is pretty good but the barrier rings, at least the really good ones that protect your skin, are horrendously expensive, so I thought the stoma paste might be a cheaper alternative.    Protecting my skin has to be my first consideration though, expense or not.   I will try the paste next time for sure.   Thanks again.

Terry

Good evening, Terry.

Rather than "tempt fate" by seeing how long I can go without a change of this system, I change my appliance on a schedule, every 3 1/2-4 days, typically Wednesday evenings and Sunday mornings or evenings. As we ostomates all have different situations, "Your results may vary." Another reason I stick to this schedule is so that I may monitor my subappliance derma, as it is prone to ulcerations and I need to try to halt any inflammation and breakdown of my skin as soon as possible.

I'm using Hollister Adapt Paste #79300 (it has alcohol in it so it may sting the skin for a few seconds upon application), and a flat, one-piece Hollister CeraPlus Premier Drainable Ostomy Pouch #8931, Ultra-Clear, Lock 'n Roll. It's more expensive than many other "standard" pouches because of its "Remois" technology, claiming to be better for sensitive skin. For me, it's true. (Thank goodness for health insurance!)

You're quite welcome, Terry. If you should think of it, please let me know how the paste works for you. :)

Lily17

Hi Lily, I know what you mean about tempting fate. I feel like I am within my safe zone with my current wear time and could probably go longer, but why take the chance? Also, like you, I'm more concerned about my parastomal skin which has been looking a little irritated, but I am still healing and still have stitches, so I'm hoping most of it is just from that. My extended health covers 70% of my ostomy supplies, so it's not a big deal really, but I have always been an unapologetic cheapskate and I'm unlikely to change at this age!

I will make a note of the Hollister pouch you are using in case my skin issues continue and I'll definitely let you know how my first "paste" attempt goes! This has been very helpful, Lily, thanks.

Cheers,

Terry

Hey guys, I fell upon this and thought it could be helpful.  

https://www.locostmedicalsupply.com/blog/all-need-know-stoma-paste/

Mike

Great find, Mike. Thanks so much!

Terry

Hi Lily, I thought I'd get your take on this. I met with my ostomy nurse yesterday and she is obviously not a fan of stoma paste. She is also not my favourite ostomy nurse and I have found they are not created equal and don't all share the same opinions. On the subject of stoma paste, first she said that because I wasn't long out of surgery, still healing, stitches still there, that I should not use the paste because of the alcohol, that it would irritate my skin. As for after healing, she said the paste is messy and that it is difficult to get off the skin when changing your pouch and that just the process of getting it off would irritate the skin. It has obviously been working successfully for you, so I'm wondering what you think? The only thing I have used thus far for removing my old pouch (and barrier) is the little packets of adhesive remover.

Many thanks!

Terry

Hi, Terry.

For heaven's sake - I wrote out a reply to your most recent item...and it's not here! Well, let me try this again:

Man, it was a long one, too. Let me see how much I can remember of it...

No matter the opinion of the medical professional, what matters most is how the PATIENT feels about the product!

RE: alcohol in paste irritating the skin, healing wounds. Yes, alcohol does sting when nerve endings are exposed. But, it's a double-edged sword, as the alcohol is also antibacterial. Now, good and bad in this, too, is that it doesn't discriminate in which bacteria to kill off. We have some good, needed bacteria on our skin, too.

If you want to try an alcohol-free stoma paste, Terry, I recommend Coloplast's Brava No-Sting Stoma Paste. If you are changing out your appliance every...2 days or less...I suggest using the Brava paste, as it will remove more cleanly from skin, stitches, wounds, than the Hollister Adapt Stoma Paste, which will likely still be very gooey and more difficult to remove at 2 days, especially from around the sutures. I can see where the nurse would have a concern, there: the last thing you want to do is be tugging on the sutures, possibly creating not only pain, but infection.

Bob and I were messaging a short time ago about paste vs. barrier ring. Never having used one before, my concern was a barrier ring's high viscosity, and not being fluid enough to fill in the "nooks and crannies" of my skin to prevent leaks. He told me that with warmth and a little pressure, a barrier ring would soften enough to create a leak-proof seal. If your sutures are located to be right under stoma paste or a barrier ring, I have to wonder how much difference there would be in adherence to the sutures - which you're trying to avoid.

I'm using the Hollister Adapt Medical Adhesive Remover spray, #7731, solely to remove my appliance. It's a tad more expensive than the original Adapt adhesive remover spray: the formulation is still the same, and great! The delivery system (can, sprayer) has improved engineering so that more of the spray can be used from the can before the propellant runs out. Less waste, and you get more product for the buck.

I use the medical adhesive remover pads to clean up any adhesive residue from my skin after appliance removal.

Well, Terry, I think I got all my points re-typed in this response. Let me know of any more questions or concerns with which I may be able to assist. :) Be well!

Lily17

Hi Lily,   I understand your frustration of typing some long response and then losing it!   It seems to happen to me a lot.   As a result, if I am going to give a response that I think will be long, I type it into a word document   and save it, then copy and paste it onto this site.   It's a bit more effort, but not as bad as having to remember and retype everything you said!

As for your advice, thanks again.   I agree that the only important opinion on product is yours, not the medical professional's.   I think I will give myself a couple more weeks to heal and then try the paste, the one I have which is the Hollister.   The only red, irritated spots seem to be right where the stitches are.    

Thanks again,

Cheers,

Terry

Hi again, friends.  I don't remember anyone suggesting Eakin Seals by Convatec.  i would peel off a portion of the Eakin Seal and roll it between my palms until it was about one-eight inch in diameter and long enough to surround the stoma.  Then I would put it in place between the stoma and the wafer and just break off the excess.  It worked very well for me but again, we're all different.

Mike

Hi, Terry!

Thanks for the reminder about saving longer responses in Word as they're being created.   : )   I've done that at work over the years, and never had an issue on MAO, before.   Good lesson for me, as many of my responses are quite long.

Be well

Lily17

Hi Mike,  This sounds like a good thing to try as I've found the Eakin Seal by itself to be way too big.  Thanks!

Cheers,

Terry

Sorry, I am jumping into this late, but I was wondering if you know how many changes you get out of a tube of stoma paste? I find them to be somewhat small (2 oz), so if you lay down a full circle of paste to protect your skin, how many of those can you get out of a tube? I'm debating whether to switch temporarily to paste vs barrier ring, partly because a box of 10 here in Canada is $75 and a 2 oz tube of alcohol-free paste is less than $20. I do not have an insurance plan, so the cost is somewhat of an ongoing concern. Just sort of doing the math in my head, I am thinking that you get slightly more than 10 changes per tube?

Thanks in advance,

Dan