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Management of a Flush or Retracted Stoma By Gloria Johnson, RN, BS, CWOCN
via The ideal stoma is one that protrudes above the skin, but this is not always possible, and a flush (or skin level) or retracted (below the skin level) may result. The surgeon may be unable to mobilize the bowel and mesentery adequately or be able to strip the mesentery enough without causing necrosis or death to the stoma. Some causes of stoma retraction after surgery may be weight gain, infection, malnutrition, steroids, or scar tissue formation. Stomas that are flush or retracted can lead to undermining of the pouch by the effluent (drainage). (Where the drainage goes below the pouch, directly onto the skin). This continued exposure can lead to irritated and denuded skin as well as frequent pouch changes. These problems can be very stressful and expensive. The inability to maintain a pouch seal for an acceptable length of time is the most common indication for a product with convexity. Convexity: Shallow: For minor skin irritations and occasional leakage. Medium: Stoma in deep folds, severe undermining, and frequent leakage. Deep: Used when medium convexity is not sufficient, stoma is retracted or lies in deep folds, leakage is very frequent, and skin is denuded. Ways to Achieve Convexity: Convex Inserts: Can be applied to a 2-piece system by snapping an insert into ring of the flange. Outer diameter must match flange size. This can be cost effective, as this insert can be cleaned and re-used. Pouches designed with Convexity: Available in both one and two piece systems. These can be shallow, medium, or deep. They come as either pre-cut or cut-to-fit. Addition of skin barrier gaskets around the stoma: Can be cut or purchased pre-cut. Can use on layer or several layers. Eakin Wafer/Coloplast Strip Paste: Product which can be pressed into shape around the stoma to protect and seal it. Other Ways to Increase Wear Time and Prevent Leakage: *Try an ostomy belt. *Make sure the opening clears the stoma only 1/8” to give the skin maximum protection. *Use ostomy paste for “caulking.” *Always read and follow the manufacturers directions for product use. Product Information: Most ostomy companies make appliances with convexity and carry convex inserts as well as belts. ConvaTec uses a product called “Durahesive” which has a turtleneck effect around the stoma. Hollister has the “Premier” series which does not erode. Nu-Hope makes barriers which are oval as well as round which have deep convexity. And New Products are added all the time. Check our your Supplier. 27 |