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Skin Burn As A Result Of Stool Fluids -advice For Treatment?

 
Posted by Past Member, on Thu Oct 15, 2009 9:46 pm
Hello

I am writing this question on behalf of my mom which is currently hospitalized after TME surgery which was held about two weeks ago.

Last June my mom was diagnosed with colorectal cancer, the surgical recommendation was TME surgery (permanent ileostomy).
About 3 days after surgery an ostomy nurse came and applied her recommended skin barrier.
A few days after, my mom started eating (she was fasting before) and the stoma equipment started liking, the ward nurses (not ostomy nurses) came and changed to a different skin barrier which didn't held on more then an hour till it started liking again, the ward nurses tried different skin barrier which were replaced on a very frequent basis but didn't solved the liking problems till the skin surroundings the stoma area (about 10 cm radius) was very red and with blisters.
As a result of this skin burn the nurses decided they can't apply any skin barrier and decide to treat the burn with some burn cream and regular bandages and when that didn't worked they changed the cream to seasorb plus bandages, also they recommended to "air "the skin surface from time to time.
Four days after still no improvement in the burn, we fell like we are caught in a vicious cycle, we can't cover the skin with skin barrier because of the burn and the burn doesn't heal since its constantly exposed to stool fluids, we are very frustrated from this whole situation and we would really appreciate any advices.
I would like to add that when the sergeant saw the burn he explained that since my mom have a big belly with some folds, we will have those issues with the skin barrier. Is there any recommended skin barrier to tackle this problem?
 
Nurse
Reply by Whoa, on Fri Oct 16, 2009 9:54 am
ISR
  I don't know if your mom is stil in the hospital or not, but she would benefit frm the ostomy nurse seeing her again.  Is there a way that could be arranged?

It sounds like the first barrier applied failed too as it leaked when she started eating.  Rule of thumb is if a lot of skin folds and "jelly belly" she may need a convex appliance, and perhaps a barrier ring (such as Eakins, Adapt or Coloplast)to fill the folds and dips, and a belt to stabilize the appliance.    If severe skin folds, she may do better with a thinner barrier and a one piece appliance.

If the skin is raw, I would rather powder than use creams as the pouch does not stick well with anything creamy.  The technique is to use Karaya or Stomhesive powder to the damaged areas, dust off the extra and seal it in to the skin with a sting free skin prep sollution (No Sting Skin prep by Smith and Nephew, Cavilon by 3 M, or Sting Free skin prep by Reliamed) before doing the rest and applying the pouch.  It may require daily or every other day changes for a week until the skin stops weeping.

Since I am not seeing your mom, an ostomy nurse follow up would be the best choice to get your mom contained.

I hope this will help.

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
 
Reply by Past Member, on Fri Oct 16, 2009 3:05 pm
Thanks so much for your advice, my mom is still in the hospital and on Sunday we have another meeting with the ostomy nurse, I will use your advices to inquaire what is the best stoma fit, hopefully it will work Smile
 
Reply by beyondpar, on Sat Oct 17, 2009 7:51 pm
Dear ISR
             the nurse who responded is right on the bullseye with her recommendations..........Karaya powder put on the blisters and then soflty with a dry cloth wiped or blown off so the excess powder is gone.....there can still be a little white left on the blisters as the littel powder left will be absorbed quickly....But most of the powder needs to be blown off...........And then you can apply the skin wafer...............And then get an OStomy nurse..........For some reason the traditional nurse just doesnt have enough training in this area to get it right.....that has ben my experience and seems to be yours as well............You will get it right so dont worry...........this solved the same problem for me within three days...........Hang in there and let me know too........An Osotmate for three years and one who has had the same problem you are experieiencing.........Michael
 
Reply by Tony, on Mon Oct 19, 2009 1:48 pm
Hi  The best thing that I have found for skin burn is 3M Cavilon No sting barrier film, sray it on and leave for a few moments to dry then replace the pouch it works for me. best regards Tony.
 
Reply by softncuddly, on Tue Oct 20, 2009 6:32 am
I think you will find everyone's response will be the key to your Mom's success. I too have the same problem and have used the methods suggest above, they do work 90% of the time, but occasionally I still do have irritation. I use the powder, spray, eakin seals, belt...etc...etc...but I also need to really make sure I have a good seal, changing too often irritates the skin, but not changing enough will also irritate the skin. I'm sure you Mom will find what works best for her and get herself into a routine. I know that creams, ointments etc cause the wafer to come loose, but if she ever has a time where she has low output and can lay still for a bit (10-15 mins) and get some aloe vera gel on the wound I have found it to help immensely. Although you cannot apply the wafer while the gel is on if you can let it absorb into the wound a bit and then wash the area, dry and apply all of the other suggestions it does help.  All of us experience similar problems and we all find solutions that work well for us....hang in there and YES the Ostomy Nurse is an amazing resource do not be afraid to ask/say anything.
 
Reply by Past Member, on Tue Oct 20, 2009 1:27 pm
Thank you all for your advices and support, after another meeting with the ostomy nurse of the hospital I found out she is not too familiar with no sting barrier products so I contact 3M in my homeland (Israel), looks like this product is pending approval (equivalent to the  FDA in USA) so I am trying to find ways to buy it.
I must say that this forum is very helpful since looks like not all ostomy nurses have the same expertise and knowledge and I am learning a lot from this forum.
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