Second, is the skin surrounding his stoma flat or recessed? If it is recessed, there are wafers that will fit into that area.
Third, is the appliance not holding onto the skin because the skin is irritated and weeping? If it is, he can soak in a tub with no appliance on and sooth the skin. Then dry it off with a soft towel and apply Maalox (yes, the stuff you drink for stomach upset) to the irritated skin with cotton balls and allow it to dry. You can help it dry with a hair dryer. Then you can apply the appliance.
I also use Convatec products, but my skin is so sensitive that the adhesive they use wreaks havoc on me. So in between the wafer and my skin I use skin barrier made by Coloplast. The Coloplast part number is 3210. This is a 4"x4" barrier and they have other sizes.
I have had weekends that were just a pure hell because my skin got so irritated. Once, I went through a dozen appliances in less than a day. eeeek. Call the hospital where his surgeon works. They usually have someone from each department on call during the weekends so someone will be able to help you with this. Plus they will also notify your doctor and the stoma nurses and keep them up to date.
Another question. Are you buying the wafers already cut to his stoma size or are you cutting the hole out yourself? Is it a tight fit around the stoma?
Great advice from everyone.
I would add: check what happens to the stoma when hubby is in a sitting position. If it is flush, often there are creases at 3 and 9 o'clock . If this is the case, prepare the skin as you did (powder, dust off, No Sting skin prep or Cavilon....or if using Maalox I would do it short term and stil prep it after).
At the 3 and 9 o'clock creases, place a small piece of Eakins (about 1/2"long) and push into place to make skin contact. Caulk where it meets the stoma at 3 and 6 o'clock. I'd cut the opening no more than a sliver larger than the stoma. Use your convex wafer and you can add an Eakins if you like. Whatever 2 piece pouch you use, add a belt, should be fairly firm which will help pull the edges down for a seal. Have your hubby lay down with hand over appliance a good 20 minutes before getting up.
Sometimes convexity works for flush stomas, sometimes you find a more flexible appliance does the trick with the fill ins. The problem with the flexible appliances (ie, Microskin or Coloplast has some very flexible ones also) is that they don't usually have belt loops.
I would continue working with his stoma nurse. My first couple of tries with educated guesses can fail too, and I try to add what I need.
Hopefully his skin is mostly just irritated around the stoma? Occ. people get contact dermatitis from the skin barrier itself and the skin basically falls apart and weeps...causing leaking. You would know if this is the issue by the pattern on the skin; skin will appear red or weepy/blistered in the exact pattern of the offending irritant. If this is the case, switching brands is suggsted. I have patch tested skin in the past, no reaction, but with entire appliance on over period of time, the skin has reacted. Just wanted to check if this was ruled out.
Fingers crossed you get this solved.
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
I just used my first moldable barrier sample ---and I must say it was very nice not having to trace & cut. If this one prevents the stool from leaking under the barrier, I think I would like to use them, definitely much quicker. The one I just put on is from Convatec, and unfortunately, his skin really reacts to their adhesive, but it was the only convex barrier I had. Thanks for your input, this site has been so helpful!!! karen