First Time with Two-Piece Pouch: Forgot Skin Barrier, Advice?

Hi all,

I just put on my first two-piece pouch system (appliance?—what is the correct term or terms?). I forgot one step. My ostomy nurse has had me using a skin barrier that makes my skin stickier. Should I take it all off, toss it, and start again? I was feeling so cocky until I saw the unopened skin barrier, lol.

Any advice about the two-piece pouches would also be welcome.

Thank you,

Lilbet

Hello, I use a 2 system as well. You can call it "Your System," "Appliance," or "Wafer & Pouch." Everyone on this site will know what you mean. It's not really necessary to use barrier film, only if your peristomal skin (skin directly around your stoma) gets irritated.

Removing the wafer.

I keep the pouch attached to the wafer while I do this. Using spray medical adhesive remover, I loosen the outer tape all around the stoma. Then switch to adhesive remover wipes to gently loosen the seal area of the wafer. Gently push in the edge of the wipe into the seal while carefully applying upward pressure. Never pull the wafer off! Hold the wafer and gently push your skin down with your fingers and use wipes. Take your time. The goal is to let the wafer fall off.

Use a remover wipe to wash away any residual adhesive around your stoma. Be careful not to hit or scratch your stoma. Be aware of where your hands are so you don't accidentally scratch the stoma with a fingernail. Stomas sometimes bleed a little; this is normal. I put the used wafer and pouch in the supplied bag found in my pouch box.

Cleaning the stoma.

Do NOT use toilet paper. Use moistened folded paper towels. It's not necessary to get it 100% clean. Just the big chunks. Taking a shower with the wafer and pouch off is great. Water will not hurt the stoma. Use a soap like Cetaphil that has no dyes, perfumes, or lotions. These chemicals will interfere with wafer adhesion. In the shower, I use wet, folded paper towels to gently rub chunks off the stoma. I put the stoma under the water stream to keep it nice and wet. I take 4 paper towels in. 2 for stoma cleaning, 2 for any stoma output. Face the shower and slightly bend forward when you shampoo/condition your hair. This prevents shampoo/conditioner from running down your stoma area. Be careful when drying off. You don't want to hit the stoma with a towel edge. I drape the towel around my neck to control it easily as I dry off my upper stomach area, neck, and arms. Pat dry the stoma area, don't rub.

Cutting the stoma hole in the wafer.

Get a portable full-length mirror to set inside your bathroom. Keeping an eye on your stoma for any "activity," use the provided measuring guide (should be in the wafer box). If your stoma is round... Lucky you. If it's oblong... It's a lot harder to match the cut hole to your stoma. It's said you should leave 1/8 inch all around the stoma. I leave more. If you cut it close, the wafer might shift after a while wearing it and rub the stoma. If this happens, your stoma will sting. Colostomy output is not super irritating to the skin. So some excess skin showing when you test fit the wafer is okay. As you cut the wafer, take your time, let your peristomal skin breathe. The longer your stoma is airing out, the better. I usually spend an hour. I could change the wafer in 10 minutes, but I don't. Make sure your skin is totally dry before you install the wafer. Unless you have skin problems, no need to use barrier film.

When the wafer test fit is good: Stand in front of the mirror. Pull off the plastic cover. Save the cover; this will be your fit guide next time you change the wafer. Carefully position and place the wafer over the stoma and against the skin. Press down the outer tape all around. Then put both hands on both sides of the wafer flange and lightly press down for a minute. Reposition hands at the flange top and bottom. Hold for a minute. Get the pouch. Check to ensure the drain at the bottom is sealed. Now you can add lubricating deodorizer to the inside of the bag if you want. I squirt it through the flange hole. Then work it around the bag, up to the bottom of the flange. I also coat the plastic opposite the flange hole. Looking in the mirror, I make sure the bag is straight down and press the flanges together at the top. Then snap the flange all the way around. I get a handheld mirror, pull up the bag, and check to see the flange bottom is properly connected. Put everything away. Tie a knot in the disposal bag, put it in regular trash. Get out there and enjoy your day.

PS: Everyone is different. I change my wafer every 7 days. Change bags 2 or 3 times a week. Just pop them off, put them in the disposal bag, pop on a new bag. Changing a wafer too frequently can damage your peristomal skin.

Hi Lilbet,

There is no rule book for this; do what works for you and don't be afraid to experiment and try different setups.

Do what works best for you.

Axl

 

I used to use barrier wipes/sprays every time I'd change my bag until I read an article from Hollister about how they recommend not using it unless your skin is irritated. So, I asked my ostomy nurse and she said the same thing. She said that in the old days they recommended using barrier wipes/sprays because the adhesive was really hard on your skin. But the newer adhesives are much easier on your skin, so they don't recommend using them unless you have irritated skin. I haven't used any barrier wipes/sprays in probably 1 1/2 years. The more simple you keep your ostomy system, the easier, faster, and less of an ordeal all this becomes.

Wow. Thank you. So much good info!

Thank you all!

Hello, fellow Minnesotan here! I always use a skin barrier, but the others who have posted are right - you really don't have to if you don't have skin irritation. When I first got my emergency colostomy on May 28 of this year, I had a 21-day hospital stay, got major irritation and blisters because it was leaking, and no one was available for a while to change it. The wound nurses don't work on the weekends at the hospital where I was, and I didn't yet know how and also had no supplies... so I just use it out of fear. But I'm going to start not using it as much and see what happens - from all I have heard, I don't really need it.

I use the 2-piece system as well, and change the whole thing twice a week, although I feel like I could probably wear it for a week. One thing that has caused me some rashes and irritation around (not under) the wafer is the Hollister Adapt Barrier Extenders - my pouch tends to lift one side due to my big scar, so I was using one of those over my wafer on that side for extra protection. But my skin doesn't like them, so I just use a piece of waterproof medical tape instead, and knock on wood, haven't had any leaks. I am fairly new to this, so I'm still learning... the others on this site have great advice!

I'm experimenting with barrier rings.

I have a parastomal hernia that tilts my stoma slightly toward my belly button. So output always goes that way.

The skin at my stoma's base is slightly uplifted like a volcano. This uplifted skin is getting beat up. I've been using a Nu-Hope hernia support belt. I wore it for a week. Then I changed the wafer.

The pressure from the belt pushed the wafer down. The hole I cut in the wafer has edges that dig into that raised skin.

The skin, especially at the bottom, looked like it had a long circular, deep scratch in it. The whole area was red.

So I ordered a Hollister 7815 2-inch slim moldable barrier ring. Note: wear gloves before handling/molding the ring.

First mistake: I thought I could stretch the ring to perfectly fit my oblong stoma. Not a chance. I ended up cutting through one side. Then I fit it at the bottom of the stoma first, then worked up and around to the stoma top. There I trimmed the ring so the ends didn't overlap. Then I cut a bigger than normal hole in the wafer larger than my damaged skin area. I installed the wafer/pouch.

I wore the hernia belt at work and while driving. About 12 hours each day.

Four days later, I removed the wafer. The skin was even worse. The ring was too thin and the diameter too small to protect the damaged skin area. Also, there were a few red spots farther away from the stoma at the bottom.

So I applied a light coating of Medline Remedy Calazine skin protectant to the damaged skin areas. Then I fitted the same type of barrier ring, squeezing it thinner to increase the diameter. But now it's thinner. I cut the same size big hole in the wafer, installed the wafer/bag. But I'm not going to wear the Nu-Hope belt. Instead, I'll use the thin, Hollister belt that clips onto the bag flange. This belt does not push in the hernia, just secures the pouch to the flange. I usually change wafers every 7 days. So next Sunday, I'll strip off the wafer and see what happened.

Last week I ordered three different types of barrier rings from different ostomy medical companies to try. My stoma sticks way out without the Nu-Hope belt on.

My wife joked: Wow... you've got a big bulge... just in the wrong place.

The saga continues.

I have forgotten the skin barrier stuff before and didn't take it off and start over. I just remembered to do it the next time. My skin was fine.

Lee

That's reassuring, thanks Lee for sharing. I viewed your profile and liked your picture. Kindly write me a message; let's correspond. OK?

G-Day InfinityCastle52777, look out for scams like the guy wanting to make contact with you. It does happen on here and we need to keep our eye on things. Regards, Iggy

That's quite low of you to say of another person..... Such disgusting way of reasoning 

Hi Beachboy, How did your new barrier rings work out?  Seems like lately I have some slight bleeding around the base of my stoma, I think this hernia is pushing it out more or something - not sure?  I have to keep cutting the hole in the wafer bigger and bigger it seems.  I just got scheduled for reversal January 30....excited but terrified at the same time!!!  Hopefully I can keep the hernia and skin issues under control until then!

Hi DexieB,

So far, so good.  Using the rings allowed my skin to heal.  I've learned to cut the ring once so it can be molded easier.  I start at stoma bottom, fitting the ring right against the stoma.  Then work my way up the sides, stopping near stoma top.  I wear gloves to prevent the ring sticking to my fingers.  I'm still working on flattening the ring so it's diameter is bigger, to cover more skin farther away from the stoma.  But doing that makes the ring thinner.

  My hernia pushes skin up at my stomas base.  I used to cut the hole in my wafer real close to the stoma.  Then I used a Nu-Hope belt to depress the hernia.  The belt pressure pushed the wafer hole down on my raised skin at stoma base, causing a long cut from the wafer hole edge.

I really like the rings because I can cut a large hole, no more precision cuts.  The ring fills the gaps perfectly.  Since I have a colostomy, my output has little liquid.  Not sure how my method would work with a ileo.

I have Coloplast and Hollister rings.  So far they perform the same.

Also read you can put on wafer, then attach the ring on the wafer right where your stoma is.  I might try this next change.

Cheers

Dixie,

I was at Mercy. The wound nurses didn’t work weekends there either, which added to my stay. Oh, I was so ready to leave after 9 days. I can’t imagine your stay. I’m glad your ok. 

where do you get your supplies. I’m using Handi Medical as they ship quickly and are a local company. 

I love the two piece Hollister. Just unsnap, clean, and snap back on. Emptying the bags was not my thing. Always feels dirty. I change 2-3 times per day. 

take care. I’m in the Northern Burbs. 
Lilbet

Thanks for the info :).  I used to put the ring right on the wafer prior to putting it on, but my wound nurse advised me to put it directly around my stoma instead now that I have a hernia.  She also mentioned I may have to move away from the type I'm using (convex Hollister 2 piece) and go to a different one if I start to get leaks ...luckily I haven't.  I do what you said - break the ring apart and put the bottom part on first.  Try to mold it but yet not make it too thin.  Working good so far!  Appreciate your response!

Haha yes, it's miserable in the hospital!  I really wasn't sure I was going to make it out.  I was in an MHealth Fairview about an hour south of the small town where I live.  I also get my supplies from Handi - they have been great so far!  I love the 2 piece Hollister....I had the drainable bags in the hospital, but I can't do that at work (and I don't like it) so I moved to the throw away bags like you.  Easy peasy! 

I'm getting my reversal January 30th - I hope it goes smoother than my emergency surgery!  It will be robotic, so I have that going for me.  And I won't be going into it with sepsis ....so hopefully an easier recovery although I will again be out of work for 6-8 weeks.  I'm terrified, but I have to try at least.  If reversal doesn't work, then at least I can say I tried.  And I've already been through the shock and emotional toll of waking up with an ostomy, so I feel ready to face what's coming - no matter how it turns out.  Thank you for your well wishes - I wish you the best as well!  

I am letting the ladies know it can happen and you did come on strong, so instead of getting your backup understand that it can and does happen. Just remember this is not a pick up club.