Am I Doing the Crusting Technique Correctly?

Can you confirm if I'm doing the crusting technique correctly for my mom? I dab a barrier film pad on the irritated skin, then put some powder over that and blow off the excess, then dab the pad. I end with the pad and let dry before putting on wafer. I just want to confirm, am I supposed to let dry between the pad and powder and pad again? I only let dry as the very last step.

Hello, I found for me that any powder simply doesn't stick no matter what I did to it.

I went through the powder, barrier wipe saga when first starting. I threw the lot in the bin in the finish.

I have learned to not use anything except warm water with a cut-up chux wipe to clean and then dry with a paper towel and hair dryer.

Any sore spots I dab with Mecuracrome, however, this is rare now as I have also learned that if I change my bag about every 3 days my skin stays healthy.

I have Crohn's, in my third year with my ileostomy and use Hollister one-piece drainable bags with a CeraRing.

Hope that info helps out.

Cheers, Ian.

You put the powder directly on the clean, dry skin, then dab with the barrier/skin protection wipe. Then repeat the process up to 3 times, building up the crust. Let dry between applications. Then apply your wafer/pouch as usual. It's called the crusting method.

Hi daughter, like DLG said, put the powder on your skin first, then dab with the pad. Let it dry and do it again and make sure you end with the pad, not powder. I used to do this with my loop ileo when my skin was constantly irritated.

Do you apply a barrier ring? I found powder and barrier wipe to be insufficient without the final barrier ring which I apply to the bag-not my skin - in preparation I precut bag, shower with no bag, while damp then place 2 folded sheets of toilet paper over damp skin and stoma keeping it covered head to my bed for a reclining position - now it's powder around stoma and outward a bit - then barrier wipe tapped on top wait to dry then apply precut bag with attached barrier ring to my skin - this along with showering naked and changing every other day sometimes two days helped tremendously- the days in between I shower with bag attached. jb

Ian,

Thank you for your response and for your tip!! I will keep that in mind!

Thank you DLG!! I was doing it wrong, I was starting with a skin barrier wipe. Thank you for explaining the correct way to do the crusting method!!!

Thank you so much! I only attempted to do the crusting method a couple of times. I am so glad I asked because I was doing it wrong and starting with the skin barrier wipe.

You've gotten good advice here. The only thing I would add is that "less is more". A very light coating of powder is better than too much, then a very light hand with the wipes as well.

Terry

Hi JB,

We started to use the ring back around Easter time but didn't use it the last time we did appliance change. (Hence why I think she got a little irritation.) Several months ago, we started to use a ring to fill in the gap because Mom's stoma got smaller and there was a tiny bit of space where stool was getting on skin. We were using a Convatec moldable appliance that fits stomas that start at 22mm and goes up to 30 something. My mom's stoma was measuring at about 22mm. Stoma nurse said we weren't getting the benefit of moldable with the size we were using so she recommended a smaller size that started at 13mm and went up to 22. Mom's stool was too pasty/thick and with the smaller size, it was leaking underneath wafer. We didn't have that issue with other size. A different nurse at Convatec advised us to go back to the original size of wafer that starts at 22 mm and use a ring for the tiny gap. Everything was going well with the ring for all these months. I was applying it directly on the skin. I think maybe I did it too snug last week and there was a tiny drop of blood when taking it down. Mom decided she wanted to not use the ring and see what happened. It wasn't bad but a tiny little area is irritated so I think we need to go back to using the rings but I need to be more precise applying it. Hopefully I made sense in this post.

Thank you, Terry. Great advice!!

Sounds like you are doing a great job and your mom is very lucky to have you as I'm sure she knows!!!

Occasionally I do get a dot of blood around the skin next to my stoma as well. Many on this site have said this is normal and not to worry.

Bless you for all you do for your mom - they are priceless and at some point in our lives, and if we are able, will give them the care they need and deserve as they have cared for us. jb

That's what I do also

What DLG said is correct. However, remember that you only need to do the crusting if there is skin irritation to begin with. If the skin is in good shape, no need to do any crusting.

Thank you for everything you said!! My mom tells me all the time how lucky she is to have me. And I feel so blessed to have her. Thank you for explaining the dot of blood is normal. I was a bit concerned with that.

Thank you, Alex. I appreciate the tip. I will only do the crusting method if the skin is not in good shape.

My WOCN emphasized making sure that the area around the stoma is absolutely dry before applying the ring. A piece of soft gauze can be used to get it totally dry. She also advised applying the ring directly onto the skin so as to get it as close as possible surrounding the stoma. I used to apply the ring to the pouch wafer but have had better luck applying it to the skin.

I use a hair blower to dry the skin around my stoma right before I put my ring on. Then I heat the ring before I apply that. All of that really helps.

The bag doesn't stick well at all if there is much of the powder. As said by others, dry the area, then put on a bit of powder in the irritated areas (I use Adapt stoma powder). I then tap the powder in the bottle down and squeeze the bottle so the air jet is aimed at the powder around the stoma. It blows the extra away while leaving a thin layer. Then I lightly dab a folded barrier wipe on that area and work my way with it all the way around the stoma area where the appliance will be. Let it dry really well before applying the appliance. If the irritation is bad, I re-do just that area with a little more powder, blow it off, then dab the barrier wipe just on that area again and dry.

It may depend on which brand of powder and what brand of appliance is used but Hollister says you can put their barrier rings or bags on right over the powder. Obviously, you don't want a bunch of extra powder on but apply the powder, remove the excess, and apply your setup. I just use the powder bottle itself (hold it straight up and powder won't come out) to blow the excess off with. Then, heat the sticky parts up with a hairdryer and everything attaches nice and tight.

While everything is off (and with a prayer to the stoma gods for flow to be quiet), letting the skin have air before doing anything is kind of like a miracle cure.

Even 5 minutes is good, but 10-20 minutes can make a huge difference. You can come up with ways to capture rogue output if you are creative, even having her stand over the toilet if she can manage that. Putting some TP in the toilet helps to keep it from splashing.