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Mixed Messages, Skin Barrier with Convex Pouch, Yes or No?

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Tue Nov 24, 2020 5:01 pm

Hi All,  I never had to use barrier rings with my colostomy, but now with the ileostomy my peristomal skin is red and irritated so I am using a barrier ring.  One ostomy nurse told me I shouldn't use a barrier ring with a convex pouch (too much pressure on the stoma she said) while another nurse told me it was fine.  I'd like to hear from any of you who have actual experience.  What do you think?  I have mostly convex pouches right now but I find they are not as comfortable as the flat flanges.  I would think that the addition of a barrier ring to the convex flange would make it even more uncomfortable?  Thanks!

 

Terry

Tue Nov 24, 2020 10:27 pm

Hi Terry,

  I've been experimenting with convex and flat barrier and ring combinations lately, so here's my 2 cents. I don't notice any difference in how a convex barrier feels compared to a flat barrier, so I can't comment on that. In regards to barrier rings......their primary function is to fill in any uneven skin (divots, dips, creases) to provide the barrier adhesive a nice flat surface to stick to. So if you have only one or two spots where the skin is uneven you can snip off pieces of the ring and apply those to only those areas of skin that need to be brought up to skin level. If your skin around your stoma is slightly uneven in a number of spots then you can thin down the ring with a rolling pin, so it's not thicker than it needs to be. Just make sure to use some plastic sheet between the rolling pin and the ring (I use the plastic wrapper my barrier comes in) or the ring will stick like glue to the rolling pin. Going the other way, if your skin is really really uneven you can stack 2 rings together.  So you have lots of options.  I'd suggest you try a few different things and see what works, because what works and what does not isn't always obvious. The first time I tried a flat barrier last week I did so with a convex ring. It all went on great......and I was sure it was going to be a winning combo.....but it leaked later that same day! 

Regards,

Bob

Axl
Tue Nov 24, 2020 10:50 pm

Hi Del

Its all in the timing.

I have used a convex bag from almost the start with a barrier ring.

I have had 4 stoma's and its always been avoid the ring until the perimiter of the stoma has healed so it doesnt stress/disrupt the healing of the join, makes sense ....

I'm going to guess and say 2 weeks or so to heal adequatley then away you go, and I'm sure you will get used to the convex pouch after a while.

Axl

 

MBT
Wed Nov 25, 2020 2:22 am

Depending on the individual stoma/peristomal contours, I have trialed a barrier ring + soft convex appliance successfully on retracted and skin-level ostomies. Occasionally, I find a situation where trying out the barrier ring isn't going to be helpful and that's obvious up front. Although they didn't work for me personally, some manufacturers offer thin versions of their barrier rings. That could be something to check out.

Wed Nov 25, 2020 9:33 am

Hi Terry is your stoma skin level like Bob posted awhile ago or is it like a spout, if so you shouldnt need an extra ring unless you have dips or contours, like i mention to Bob when you take the wafer off for a change look at the back side of it and see where its eroded away the most and maybe try a peice of a ring/seal there or like Lily does use some paste in that area as filler or even all the way around the opening, the paste stings some but also helps heal i think.  good luck 

Wed Nov 25, 2020 10:02 am

I,put karaya powder around the stoma using skin protector wipes to make the powder stick.  Then I contour an Eakin seal to fit snugly around the stoma.  Then I apply the Convatec convex wafer, after ensuring the entire area is dry.  I use a Coloplast brava strip on the bottom of the wafer, making sure the strip halfway covers both the edge of the wafer and the surrounding skin. I have no leaks, and get 5 days of wear with this system.

Wed Nov 25, 2020 4:01 pm

Thanks to all of you for the good advice and tips.  Lots of things to consider. 

 

Terry

Wed Nov 25, 2020 4:04 pm
MOST52 wrote:

I,put karaya powder around the stoma using skin protector wipes to make the powder stick.  Then I contour an Eakin seal to fit snugly around the stoma.  Then I apply the Convatec convex wafer, after ensuring the entire area is dry.  I use a Coloplast brava strip on the bottom of the wafer, making sure the strip halfway covers both the edge of the wafer and the surrounding skin. I have no leaks, and get 5 days of wear with this system.


Where do you get karaya powder?  Do you find that it works better than regular stoma powder?  Many thanks.

 

Terry

Wed Nov 25, 2020 9:00 pm
delgrl525 wrote:


Where do you get karaya powder?  Do you find that it works better than regular stoma powder?  Many thanks.

 

Terry


I buy from Parthenon (sp).  It's more healing than other powders in my opinion.  I sometimes get a little reddening around the stoma and karaya seems to provide a better coating.  Happy Thanksgiving!

Fri Nov 27, 2020 3:53 pm

Hi there - since I have the ileo critter and have had to have several revisions because it keeps narrowing, I have always used convetec convex, And recently (this last year) I have had to add a cut down barrier ring.  The size opening is too big so I cut out a wedge and reseal it.  Then I take the portion cut off to make an extra small ring to sort of fill in where my last stoma was, just below this one.  I don't want any more surgeries after all the crap I have gone thru with scar tissue etc.  My bladder had been rebuilt twice due to the bowel growing on it. I got the hernia mesh to keep it from dropping into my pelvis once again, but after my accident l2 years ago with multiple pelvic fracture, I am afraid the mesh isn't doing its job.  Been in hospital already twice qwith dehydration, and once with a bowel obstruction. So I can manage my stoma but have increasing bladder problems.  sigh

So that is my story - wish it was better

Judi

Fri Nov 27, 2020 4:47 pm
JudiA wrote:

Hi there - since I have the ileo critter and have had to have several revisions because it keeps narrowing, I have always used convetec convex, And recently (this last year) I have had to add a cut down barrier ring.  The size opening is too big so I cut out a wedge and reseal it.  Then I take the portion cut off to make an extra small ring to sort of fill in where my last stoma was, just below this one.  I don't want any more surgeries after all the crap I have gone thru with scar tissue etc.  My bladder had been rebuilt twice due to the bowel growing on it. I got the hernia mesh to keep it from dropping into my pelvis once again, but after my accident l2 years ago with multiple pelvic fracture, I am afraid the mesh isn't doing its job.  Been in hospital already twice qwith dehydration, and once with a bowel obstruction. So I can manage my stoma but have increasing bladder problems.  sigh

So that is my story - wish it was better

Judi

Hi Judi,  You poor thing, it sounds like you have been through Hell!  I appreciate the advice and I hope things get better for you.

All the best,

Terry

Fri Nov 27, 2020 8:35 pm
JudiA wrote:

Hi there - since I have the ileo critter and have had to have several revisions because it keeps narrowing, I have always used convetec convex, And recently (this last year) I have had to add a cut down barrier ring.  The size opening is too big so I cut out a wedge and reseal it.  Then I take the portion cut off to make an extra small ring to sort of fill in where my last stoma was, just below this one.  I don't want any more surgeries after all the crap I have gone thru with scar tissue etc.  My bladder had been rebuilt twice due to the bowel growing on it. I got the hernia mesh to keep it from dropping into my pelvis once again, but after my accident l2 years ago with multiple pelvic fracture, I am afraid the mesh isn't doing its job.  Been in hospital already twice qwith dehydration, and once with a bowel obstruction. So I can manage my stoma but have increasing bladder problems.  sigh

So that is my story - wish it was better

Judi


I'm so sorry for all your difficulties.  You have endured so much.  I will pray that better days are ahead for you,Judi

Nurse
Mon Nov 30, 2020 8:51 am

I asked the stoma nurse recently if one should use a barrier cream and she said no . I’m  concerned when I see red irritated skin yet she says use the powder , what do members say. Do many use creams and if so do they prevent bag adhesive from sticking well ? TIA 


_________________
Career/nurse for Spouse
Mon Nov 30, 2020 4:02 pm
Jubilee wrote:

I asked the stoma nurse recently if one should use a barrier cream and she said no . I’m  concerned when I see red irritated skin yet she says use the powder , what do members say. Do many use creams and if so do they prevent bag adhesive from sticking well ? TIA 


Hi Jubilee, When you say cream do you mean paste?  I'm not sure what stoma cream is but I have been thinking of trying stoma paste instead of using the barrier ring.  Is this what you meant? 

 

Terry

Nurse
Tue Dec 01, 2020 6:31 am

I mean a cream it’s advertised as cream , Brava make one to go on skin around stoma. Seems Stoma nurse doesn’t approve .


_________________
Career/nurse for Spouse
Mon Dec 14, 2020 5:02 pm
Jubilee wrote:

I asked the stoma nurse recently if one should use a barrier cream and she said no . I’m  concerned when I see red irritated skin yet she says use the powder , what do members say. Do many use creams and if so do they prevent bag adhesive from sticking well ? TIA 


I was told by my colosnostomy nurse to never use creams or powder. They can case your bag to leuk if you dont use them properly. She advised me to let my skin breath in between bag changes so i take my bag off take a shower, have a coffee. I have extremly sensitive skin, i had a allergic reaction tp the bandages in the hospital. I still have a bit of redness but letting it breath a bit has helpt. But i have only had my colonostomy bag for 1,5 months so i dont have that much experience.

Axl
Tue Dec 15, 2020 4:50 am

Hi Lisalyn

I and others use this and it works very well, I use it every change as a preventative.

https://www.alphamedicalsolutions.com.au/cavilon-spray/?gclid=Cj0KCQiA2uH-BRCCARIsAEeef3l74eKY3faxEs3BkUoAs1_DmysmNsaHk_jE2pYe85NO3ekMZEH2wCgaAi31EALw_wcB

 

Axl

 

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