Opinions on crusting for peristomal skin irritation?

Have any of you had any good or bad experiences with "crusting"? I do not do it, but a loved one of mine has visiting nurses that insist on performing it on them. It is done by applying a skin protective layer and then stoma powder in sequence 4 times, and then the barrier ring is applied. I believe it is irritating rather than aiding the peristomal skin. Opinions?

I use a simplified version. I only use two layers. Also, I am very careful that my skin is completely dry before I apply the powder. I brush off as much powder as possible. Lastly, I do not use paste adhesive but create my own sealing from a Brava barrier strip. My skin heals nicely when I do have tender places and it is easier to remove the old flange when it is time to change bags.

My personal thoughts are that the more simple, the better. Unless my skin is irritated, I don't do anything but stick the wafer on. The people at Hollister Secure Start told me this from the beginning, and it took me a while to trust their advice, but in the end it worked best for me.

So what happens if they don't do it?

I think all is really said well with your word "insisting". Turn the tables around. Get educated on best procedures, and direct your nurses. You insist on what's best. If you're not the caregiver, it sounds like you could be a caregiver. Jump in. Take the reins. You care so much more about your loved one than the nurses do. So get proactive.

We had a couple of nurses who refused to listen to me. I demanded and got new nurses. This was home nursing, not in the hospital.

What they were doing wrong was not brushing the excess powder off, and the adhesive did not stick well.

I have had very good luck with crusting. I have had a reversal with some complications and had to wear bandages for quite a while and I used the crusting technique for them as well.

I use spray adhesive removal and spray skin prep for my crusting. I spray adhesive removal directly on the outside of the bandage or barrier and it makes it gummy and easier to remove without tearing the skin.

I make sure to remove any other products with soap and then dry the area completely.

I spray the prep then powder the area and fan off excess. I make sure each layer is completely dry before adding a new one.

I had an inverted stoma and couldn't secure the bag well enough to protect my skin from contact with feces. Crusting only helped me with the adhesive area. I had a reversal sooner than I expected because of it.

It was actually a pain to have to do but it helped some. If your friend doesn't need it, why bother?

Charlotte