Stoma care

The main principles of stoma care are to provide the patient with a well-fitting, comfortable appliance and to maintain skin integrity.

The skin around the stoma should be protected by ensuring the aperture (hole) of the appliance is cut to the correct size. There should be no more than 1-2mm of exposed skin when the appliance is placed in situ. A measuring guide or template should be used – all patients should be provided with these but, if not, they are available in stoma care resource files or from the stoma care nursing teams. The measuring guide is placed over the stoma and the nearest size chosen.

When a healthcare professional/carer is performing stoma care, standard infection control precautions should be applied.

Stoma appliances

There are mainly three types of stoma care appliances; closed, drainable and urostomy. Appliances can be one piece (where the adhesive or 'flange' is integral to the pouch) or two piece (where there is a separate flange with a pouch that clips or sticks on to it). The stoma output determines the choice of appliance.

The stoma care nurse will provide each patient with a choice of appliances suitable for their individual needs.

Accessory products can be useful for problematic stomas but, as a general rule, stoma care should be kept as simple as possible.

Out of hours emergency supplies may be obtained from some Community Hospitals or according to local arrangements. The stoma care link nurse is responsible for maintaining an adequate supply of closed and drainable appliances.

This formulary does not cover appliances as they are patient specific.

Guidelines for changing a stoma appliance

Equipment Required

  • Disposal Bag
  • Tissues / Dry Wipes
  • Warm Tap Water
  • Measuring guide
  • A new appliance
  • Scissors
  1. Get all equipment ready before you start.
  2. If a drainable pouch is used, empty first.
  3. Gently peel the appliance away from the skin, using one hand to support the skin to prevent trauma.
  4. Fold the flange of the used pouch in two to seal and place in disposal bag.
  5. Using a dry tissue, first remove any soiling from skin and stoma.
  6. Using a wipe moistened with water, wash the stoma and surrounding skin.
  7. Dry the skin thoroughly.
  8. Measure stoma using measuring guide or template – cut the pouch to correct size.
  9. If using accessory products apply now.
  10. Remove adhesive backing from pouch and secure pouch over stoma. Hold in place with warm hand for a few minutes to encourage adhesion.

Disposal of Equipment

Stoma care equipment for patients in the community can be disposed of with household waste once tied in a disposal bag (or nappy sack).

Skin care

Patients should not expect to get sore skin around the stoma. If skin is sore refer to descriptions below, products listed on subsequent pages and refer to stoma care specialist service if problem does not resolve.

Normal Skin

If a patient presents with a suddenly enlarged stoma or a bulge at the side of their stoma (hernia), assess that the stoma is pink, healthy and active. If so, offer reassurance, ensure that the appliance template is still correct and adjust accordingly, and refer to the stoma care nurse as soon as possible. If concerned about the colour, bleeding or pain, please seek medical advice.

Slightly Pink Skin (mild erythema)

Assess technique especially removal of pouch, which may be causing localised trauma. Ensure that the appliance template is still correct and adjust accordingly.

Treatment guideline – consider use of adhesive remover

Moderately Pink Skin (moderate erythema)

Assess technique, especially removal of pouch. Ensure that the appliance template is still correct and adjust accordingly. There should be no more than 1-2 mm of exposed skin when the appliance is placed in situ. Re-size bag if appropriate.

Treatment guideline - consider use of protective wipes (Pelican)

Red Inflamed, Dry, Angry Skin (severe erythema)

Assess technique, especially removal of pouch. Ensure that the appliance template is still correct and adjust accordingly. There should be no more than 1-2 mm of exposed skin when the appliance is placed in situ. Re-size bag if appropriate.

Refer back to clinician to rule out infection.

Treatment guideline - consider use of protective barrier wipes

Red, Inflamed and Moist Skin

Assess technique, especially removal of pouch. Ensure that the appliance template is still correct and adjust accordingly. There should be no more than 1-2 mm of exposed skin when the appliance is placed in situ. Re-size bag if appropriate. Refer back to clinician to rule out infection.

Treatment guideline - consider use of protective powders

 

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