Crusting Method

1. Clean the area with warm water.

2. Dry the area. Use a soft cloth or paper towel.

3. Dust ostomy powder onto the irritated skin.

4. Brush off any extra powder with a tissue or paper towel. This keeps the powder from clumping.

5. Blot or Spray the irritated skin with skin sealant or equivalent product.

(Note - These wipes are not the same as alcohol wipes. In fact, they have no alcohol in them.)

6. Allow the area to dry. (About 15-30 seconds)

7. Repeat these steps another 2 times, if the skin is still moist.

8. Apply your pouching system as you normally would.

9. Change your pouching system every 2-3 days until the skin heals. Repeat these steps every time you change your pouching system until the skin is healed and healthy.

10. Return to your usual routine for caring for your ostomy when your skin is healed and healthy.

What you need (examples of products):

 

• Skin Sealant:

−− 3M Cavilon

−− Smith & Nephew Sting Barrier wipes/spray

−−An equivalent product

 

• Ostomy Powder:

−− Stomahesive Powder (Convatec)

−−Coloplast Ostomy Powder (Coloplast)

−−Adapt Stoma Powder (Hollister)

−−An equivalent product

Order the crusting products from your supplier.

Do not use crusting as part of the regular care of your ostomy (unless your Ostomy nurse has instructed you to use it).

Reference:

Caring for Your Ostomy: What You Should Know

St. Paul’s Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 2K5

2014. My thanks to Neal Dunwoody RN, CWOCN

Summary of Principles in Managing Peristomal Breakdown

Determine and correct causative factors.

Treat skin to promote healing and to have a pouchable surface.

Refer to physician example dermatologist if you are unsure of problem, or if the issue is not resolving.

Dermatologic condition may manifest in peristomal area and may not be related to products or leakage.

Reference: Emory University, 2013

Mucocutaneous Junction Separation: Prevention and Management

Prevention:

Maximize nutritional status before surgery

Address and correct any systemic factors which may predispose patient to poor healing at surgical site


Management:

Local wound healing—use of absorptive powder (example ostomy powder) or aliginate dressing and cover with ostomy ring, steristrips, thin hydrocolloid, or ostomy paste

Systemic measures to support wound healing

Reference: Emory University, 2013

Mucocutaneous Junction Separation

 

 

Partial or complete separation of the stoma from the peristomal skin due to suture line breakdown. SQ fat and serosal layer of the bowel may be visible.

 

Use of steroids, infection, malnutrition, and abdominal radiation are contributing factors.

Because of tension the ostomy is separating from the skin or it could be that the opening in skin is too large for stoma.

Reference: Emory University, 2013

Mechanical Injury

Image is from wocn.org

 

 

Patchy areas of superficial skin loss corresponding to areas of trauma

Can be full thickness skin loss

Caused by improper removal of tape or barrier

May also be caused by scrubbing or picking on skin

Abrasive cleansing techniques

Convex pouching system

Ill-fitting pouching system

Ostomy belt and rigid appliances

Reference: Emory University, 2013; WOCN, 2007

 

 

Treatment:

 

 

Eliminate causative factor.

Crusting denuded areas.

If areas ulcerated, consider use of calcium alginate, hydrofiber, or hydrocolloid dressings, before applying pouching system.

Do not use skin sealants with alcohol as they sting.

Education of patient and/or caregiver.

 

Reference: WOCN, 2007

 

Prevention:

 

Gently cleanse the skin. Avoid picking.

Gently remove pouching system. Consider use of adhesive remover.

Consider use of skin sealants under adhesives.

Avoid use of cement and strong adhesive spray.

Ensure proper fit of pouching system.

If belt used—make it snug, not tight. May have to use wider belt.

Reevaluate need for convexity.

 

Reference: Emory University, 2013; WOCN, 2007

 

 

Candidiasis or Monilial Rash or Fungal "Yeast" Dermatitis

This image is from http://www.oley.org/lifeline/TubetalkMA07.html



Also known as monilial rash or candidiasis

Discoloration—redness or darker

Pigmentation

Papules and pustules may be present

Maceration with satellite lesions

May be pruritic

Caused by body perspiration, denuded skin, or leaking pouch system

 

Predisposing factors: diabetes mellitus, immunosuppression, oral contraceptive use, steroid use, and antibiotic use

Treatment: usually antifungal powder and skin prep. “Crusting” method.

Reference: Emory University, 2013; WOCN, 2007








Prevention:

•Eliminate moisture by using a properly fitting pouching system

•Consider use of a pouch cover or pouch with a cloth backing

•Dry pouching system well after swimming, bathing, showering, or after being in contact with water or steam.  Use of hair dryer on the coolest setting to dry pouching system should be considered.

•Consider use of prophylactic treatment if a pattern of getting fungal infection established, example if patient gets it when on antibiotic therapy.

Reference: WOCN, 2007