Stoma Appliance Research Articles

Colostomy irrigation: implementing structured protocol-led follow-up.

Colostomy irrigation is a procedure that allows patients to achieve a certain degree of bowel control, and a period free of stoma effluent. It has the potential to improve quality of life, body image and confidence, and reduce patient anxiety. It may also help reduce odour and flatus, prevent/address peristomal skin irritation and alleviate constipation. Because it can reduce or eliminate the need for a colostomy bag, it may also cut expenditure on stoma appliances. However, colostomy irrigation is not offered to patients as standard. A protocol was drawn up to ensure colostomy irrigation was routinely offered to suitable patients and to provide them with a structured follow-up to ensure they were well supported throughout the first year of carrying out the procedure. Quality of life and the efficacy of colostomy irrigation can be monitored using questionnaires on these two issues. Two case studies demonstrate how patients' quality of life can improve when using colostomy irrigation as part of their stoma care routine.

Enhancing Stoma Care Education for Junior Doctors: A Comprehensive Teaching Series.

Introduction Colorectal stomas are prevalent in surgical wards and demand careful medical attention, particularly in stoma management. Junior doctors play a vital role in this care, but their limited exposure and training may hinder their ability, impacting patient care. Given the dearth of literature, we aimed to assess junior doctors' stoma care knowledge and the efficacy of a specialized teaching course in boosting their confidence and skills. Methods The research, conducted at the West Suffolk Hospital NHS Trust in the UK, engaged 60 junior doctors, predominantly from Foundation Year 1 and Year 2, from August 2021 to December 2022. To ensure effective management and assessment, participants were divided into four groups, each comprising 15 doctors. A pivotal aspect of the study was implementing a structured stoma teaching series delivered by a panel of seasoned surgical experts. This series, conducted every Friday for three weeks, comprehensively covered all facets of stoma care. Both before and after the teaching series, assessments were administered to measure the impact of this educational intervention on the participants' understanding of stomas. The study meticulously adhered to ethical guidelines, with all participants providing informed consent, and measures were implemented to guarantee anonymity, thus safeguarding the privacy and confidentiality of all individuals involved. The primary objective of this investigation was to evaluate the efficacy of the stoma teaching series in augmenting the knowledge and comprehension of stomas among junior doctors. The findings of this study hold significant potential in guiding healthcare professionals toward developing more efficacious stoma education programs, ultimately leading to improved patient care outcomes. Results The study involved 60 junior doctors categorized into four groups from August 2021 to December 2022. It aimed to assess their understanding of colorectal stomas, focusing on complications and their knowledge about stoma appliances and care nurses. A questionnaire was used to evaluate their knowledge in these areas at the start of their surgical rotation, which showed significant knowledge gaps among participants. Of the 60 participants, 48 (80%) expressed slight or no confidence in basic stoma care, while 54 (90%) admitted unfamiliar with managing stoma complications. Astonishingly, all 60 (100%) participants lacked awareness of fundamental stoma care concepts. Significant improvements were observed following a comprehensive stoma teaching series covering basic stoma knowledge, its complications and management, and practical stoma care. Feedback from the course revealed positive outcomes, with 54 (87%) doctors feeling confident or very confident in basic stoma knowledge and 48 (80%) reporting increased familiarity with managing stoma complications. Remarkably, all 60 (100%) doctors indicated comfort with stoma care concepts after the sessions. Participants emphasized the course's value in medical education and professional development, citing enhanced practical skills such as communication and teamwork. Conclusion Our study revealed junior doctors' limited stoma knowledge, emphasizing the need for a dedicated teaching program that significantly improves their understanding.Focused stoma education is vital for junior doctors to deliver optimal patient care, necessitating hospitals to promote awareness for improved patient outcomes.

Ileostomy 101: Understanding the Basics for Optimal Patient Care.

This comprehensive literature review explores the foundational aspects of ileostomy, encompassing surgical techniques, postoperative care, complications, and advancements. Ileostomy, a surgical procedure redirecting the ileal lumen through an abdominal opening, is a critical intervention for various gastrointestinal conditions. The review delves into surgical techniques, emphasizing the importance of stoma location and type selection, whether temporary or permanent. Complications associated with ileostomy are discussed, highlighting the significance of vigilant postoperative care, including stoma care and addressing potential complications. The profound impact of ileostomy on patients' quality of life is elucidated, underlining the necessity for a holistic approach to patient care. Additionally, advancements in the field, such as biodegradable stoma bags, smart stoma appliances, and telemedicine, are explored for their potential to enhance patient outcomes. The review emphasizes the need for individualized approaches and ongoing research to maximize the benefits of these advancements for ileostomy patients and improve their overall experience.

Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex.

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.

Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex.

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.

Peristomal Hidradenitis Suppurativa: A Case and Review of the Literature

Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of apocrine gland-bearing skin that typically presents as deep, inflamed lesions in the axillary, inguinal, perineal, and mammary regions. We present a rare case of a man in his 60s with a history of HS who presented with a peristomal sinus tract, as well as non-healing, draining wounds around his stoma site that responded well to adalimumab therapy. A compounded clobetasol ointment with poly(ethelyene oxide) polymers (POLYOXTM, Dupoont) was utilized to maintain stoma appliance adhesion, and his lesions effectively cleared with adalimumab.

Cancer Resource and Information Support (CRIS) for Bladder Cancer Survivors and Their Caregivers: Development and Usability Testing Study.

Bladder cancer survivors and their caregivers face profound practical (eg, use of stoma appliances and care for urinary diversion methods) and psychosocial (eg, depression and anxiety) challenges after surgical treatment with cystectomy. To improve the health-related quality of life and postsurgical outcomes of both bladder cancer survivors and their caregivers, the team, in collaboration with Sourcetop, Inc (software design) and Dappersmith (graphic design), developed the Cancer Resource and Information Support (CRIS) software. The purpose of this manuscript is to report on the development and usability testing of the CRIS software. The development of the CRIS software was guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model for developing behavioral treatments for chronic diseases. The ORBIT model is unique in that it proposes a flexible and progressive process with prespecific clinically significant milestones for forward movement and returns to earlier stages for refinement, and it facilitates communication among diverse groups by using terminology from the drug development model. This paper focuses on 2 phases of the ORBIT model: phase IA: define and IB: refine. During phase IA, the study team developed solutions for the stated clinical problem-adjustment to life post cystectomy-by reviewing the literature and collecting feedback from clinicians, professional organizations, bladder cancer survivors, and their caregivers. During Phase IB, the study team focused on tailoring content in the CRIS software to the user as well as usability testing with 7 participants. The finished product is CRIS, a web-based software for survivors of bladder cancer and their caregivers to serve as a health management and lifestyle resource after surgery. Overarching themes from phase IA (participant feedback) included how to use new medical equipment, tips and tricks for easier living with new medical equipment, questions about health maintenance, and questions about lifestyle modifications. To accommodate our target population, we also incorporated recommendations from the Americans with Disabilities Act for website design, such as large text size, large paragraph spacing, highly contrasting text and background colors, use of headings and labels to describe the purpose of the content, portrait orientation without the need for horizontal scrolling, multiple ways to access a web page within a set of pages, ability to navigate web pages in sequential order, and in-text links that are descriptive. Usability participants evaluated CRIS very positively, indicating that it was easy to use, the functions were well-integrated, and if available, they would use CRIS frequently. CRIS, developed over the course of 18 months by integrating feedback from experts, literature reviews, and usability testing, is the first web-based software developed for bladder cancer survivors and their caregivers to help them adjust to life following cystectomy. The efficacy of CRIS in improving patients' and caregivers' quality of life is currently being evaluated in a randomized controlled trial.

Understanding and Managing Hepatic Disease, Portal Hypertension and Stomal Varices

Scarring (cirrhosis) from advanced liver diseases can block normal hepatic circulation of blood through the liver, causing increased pressure in the venous portal system (portal hypertension). This can result in pressurised veins (varices), usually in the gastro-oesophageal region, which are liable to bleed. Variceal bleeding is dangerous, leading to haemodynamic destabilisation and death, and thus requires emergency intervention. Treatments include medications and endoscopic suturing, sclerotherapy, ligation or embolisation. Transjugular intrahepatic portosystemic shunt (TIPS) is a high-risk option that can relieve the underlying portal hypertension. People with a stoma and cirrhosis may develop peristomal varices (caput medusae), which are at risk of copious bleeding. These require immediate treatment, followed by the stoma care nurse reconsidering the stoma management routine and appliance use to reduce the risk of rebleeding.

Stoma product selection: an update

There are three main output stomas-colostomy, ileostomy and urostomy. Each of these requires a different stoma appliance to collect and contain the stoma output. This article discusses stoma product selection, things to consider before choosing a product, as well as caring for the stoma.

Convexity in stoma care: developing a new ASCN UK guideline on the appropriate use of convex products

One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. However, the use of a convex appliance should be considered only after a thorough assessment has been undertaken by a specialist SCN. Professionally, stoma care nursing has advanced greatly in recent years and there has been a realisation that there is a need for clinical guidelines to direct practice and offer a process for the novice SCN to follow. This realisation has been the catalyst behind the development of the new guideline for the assessment and use of convexity by the Association of Stoma Care Nurses UK, which was published this year ( https://ascnuk.com/ ). This article explores the concept of convexity and how the guideline can assist the practice of specialist SCNs, as well as that of ward and community-based nurses who wish to gain more information on using convexity within the specialist sphere of stoma care.

Diagnosis, Treatment, and Prevention of Ileostomy Complications: An Updated Review.

An ileostomy is associated with multiple complications that may frequently or persistently affect the life of ostomates. All healthcare professionals should have knowledge of the diagnosis, treatment, and prevention of ileostomy complications. Peristomal dermatitis is caused by watery and highly alkaline effluent. Skin protective products are typically used for local treatment. Ischemia/necrosis occurs due to insufficient arterial blood supply. Retraction is seen in patients with a bulky mesentery and occurs following ischemia. Convex stoma appliances can be used for skin protection against fecal leakage. Small bowel obstruction (SBO) is common and occurs only at the stoma site. Trans-stomal decompression is most effective in these cases. High output stoma (HOS) is defined as a condition when the output exceeds 1,000- 2,000 ml/day, lasting for one to three days. Treatment includes intravenous fluid and electrolyte resuscitation followed by restriction of hypotonic fluid and the use of antimotility (and antisecretory) drugs. Stomal prolapse is a full-thickness protrusion of an inverted bowel. Manual reduction is attempted initially, whereas emergency bowel resection may be needed for incarcerated cases. A parastomal hernia (PSH) is an incisional hernia of the stoma site. Surgery is considered in cases of incarceration, but most cases are manageable with non-surgical treatment.

An Intriguing Case of Chronic Peristomal Ulcer.

An Intriguing Case of Chronic Peristomal Ulcer.

Results of an audit of the Peristomal Body Profile Assessment Tool

Leakage is the number one concern for people with an ostomy. The 2019 Ostomy Life Study, a global study of more than 5000 ostomates, showed that 92% of people living with a stoma worry about leakage. Getting the right stoma appliance for each patient is key to increasing patient quality of life. The study was designed to assess the use of the Peristomal Body Profile Assessment Tool in helping choose the most appropriate stoma products for a given patient, decreasing incidents of leakage and peristomal skin complications. A multi-centre (33 sites, 147 patients) low-interventional clinical investigation was conducted in which the use of the Peristomal Body Profile Assessment Tool was evaluated as a tool to reduce incidents of leakage, increase peristomal skin health and increase patient quality of life. A focus group of randomised participating clinicians (n=16) was held to explore the audit results. The assessment tool most often took between 2 and 5 minutes to complete. It supported clinicians in selecting the right appliance for each patient, avoiding leakages and preventing associated peristomal skin complications. The assessment tool helped improve the accuracy and quality of documentation in the patients' medical/nursing notes, increasing the quality and continuity of care. Participants reported that using the assessment tool helped reduce care costs by reducing the need for product changes, supporting product usage and return patient visits. Use of the Peristomal Body Profile Assessment Tool helped clinicians choose the most appropriate stoma appliance the first time, resulting in patients having healthier peristomal skin, fewer leakages, more confidence in their stoma appliance and a higher quality of life.

EE638 Consumption of Stoma Appliances and Supporting Products Among Persons Living With a Stoma: A Swedish Register Study

EE638 Consumption of Stoma Appliances and Supporting Products Among Persons Living With a Stoma: A Swedish Register Study

The Benefits and Drawbacks of Staging Pelvic Pouches.

Since the mid-20th century, physicians have searched for way to improve the lives of patients with ulcerative colitis (UC). Early attempts of curative resection left the patients with a permanent stoma with only primitive stoma appliances available. Gradually, stoma care improved and operations were devised to give the patient bowel continuity without the need for a permanent ostomy. As these operations were evolving, benefits and drawbacks related to fertility, ease of small bowel reach to the pelvis, and postoperative pelvic sepsis were observed. In this article, we will elucidate the various ways pelvic pouches are used to treat UC and the rationale for the timing of surgery as well as the evolution of stoma care.

Evolving stoma appliances to improve patient outcomes and increase stoma acceptance.

Adjusting to life with a stoma can be difficult physically and emotionally. Preoperative counselling, where possible in cases of elective surgery, is fundamental to preparing those facing stoma formation, and a lack of support can be detrimental and can increase the risk of stoma patients experiencing complications. The stoma care nurse specialist (SCN) uses a range of clinical skills and specialist knowledge to support a patient through their surgical pathway; this is important for helping patients gain the skills and confidence to care for their stoma and reduce the risk of stoma-related complications. Complications are common and can reduce patient wellbeing and quality of life. As well as patient education and SCN support, using the appropriate stoma care appliances is important in achieving positive outcomes and preventing complications. Furthermore, the correct appliance for an individual patient can help to improve their confidence and wellbeing, leading to better stoma acceptance by meeting their needs and allowing them to carry out everyday life without feeling obstructed by having a stoma pouch. This article discusses the Aura Plus stoma pouch range, and highlights the features designed to prevent common complications and improve patient outcomes and confidence. A case study demonstrates how Aura Plus led to positive outcomes for a patient who had been experiencing significant leakage and peristomal skin complications when using a multitude of different pouches. The change to Aura Plus resolved these complications and led to improved wellbeing and quality of life.

Continuing Care Bundle in Elderly Patients with Rectal Cancer after Radical Resection with Permanent Stoma.

Objective A continuing care bundle can achieve a better outcome than a single implementation after discharge. This study aims to investigate the effect of this intervention in elderly patients with rectal cancer after radical resection with a permanent stoma. Methods Elderly patients diagnosed with rectal cancer underwent radical resection with permanent stoma, they were divided into the control group (n = 42) and bundle group (n = 42). The control group received the conventional care, and the bundle group received the continuing care bundle in addition to the conventional care. At 1- and 3-month after discharge, self-efficacy, self-care knowledge, ability to change stoma appliances, negative emotions, quality of life, and patient satisfaction were observed. Results The increased levels of self-efficacy, self-care knowledge, and ability to change stoma appliances were displayed in the bundle group after discharge as compared with that in the control group, along with the enhanced score of SF-36 subscales, including physical function (PF), role physical (RP), global health (GH) and vitality (V), social function (SF), and mental health (MH). Furthermore, patients showed alleviated depression and anxiety after the continuing care bundle as compared to those after conventional care. Besides, the bundle groups had higher patient satisfaction than the control group. Conclusions Continuing care bundle can serve as an effectiveness intervention in elderly rectal cancer patients after radical resection with permanent stoma via increasing self-efficacy and self-care knowledge, enhancing the ability to change stoma appliance, reliving the negative emotion, and improving quality of life and patient satisfaction.

Utilities associated with stoma-related complications: peristomal skin complications and leakages

Aim Peristomal skin complications (PSCs) and leakages are major issues for people living with a stoma. The purpose of this study is to understand how these stoma-linked complications impact health-related quality of life (HRQoL) in a UK population. Materials and methods The study used time trade-off (TTO) methodology to quantify health state utilities associated with two stoma-related complications: PSC and leakages. Respondents assessed 10 different health states with different PSC severity levels (no, mild, moderate or severe PSC) and frequencies of leakage events (2, 12 or 48 leakages onto clothes per year, and no leakage due to a digital solution). The average disutility value for each health state was also assessed. The study was conducted via a web-based survey in the UK adult general population. Results and limitations The analysis included 758 respondents. Respondents considered living with a stoma with no PSC to be more favorable than the other health states. Severe pain, itching and/or burning (PIB) was associated with the largest disutility compared to no PSC. The disutility (0–1 scale) compared to no PSC was 0.287 (p < .0001), 0.106 (p < .0001) and 0.025 (p=.0005) for PIB scores of 8, 5 and 2, respectively, on a 1–10 scale. More frequent leakage events were associated with lower utility. The utility decreases compared to no PSC were 0.114 (p < .0001), 0.057 (p < .0001) and 0.022 (p < .0001) for 48, 12 and 2 leakage events per year, respectively. The health state with a digital notification solution that notifies the user before a leakage event happens was considered as good as no PSC. Conclusions Experiencing mild, moderate, and severe levels of PSC or leakage onto clothes is associated with a significant reduction in HRQoL compared to no PSC and/or no leakage. Stoma appliances that reduce the skin complications or keep leakage from reaching the clothes are likely to improve HRQoL.

RWD126 A Comparative Product Consumption Analysis Among New Stoma Appliance Users Utilizing Real-World Evidence

A high consumption of stoma appliances and supporting products (SP) can indicate stoma-related challenges with leakage and peristomal skin complications (PSC). The objective of this retrospective analysis was to assess differences in consumption of ostomy bags, plates and SP among new stoma appliance users in United Kingdom (UK) using either Coloplast Sensura Mio® (SM) or SALTS Confidence BE® (CB).

Stoma product selection: a guide for community nurses.

With 205 000 people in the UK with a stoma, it is likely that community nurses will need to consider which stoma products are most appropriate to use with this group of patients. This article explores the three output stomas, what stoma appliances are most commonly used for each type of stoma and why. Understanding how often stoma appliances should be changed empowers the community nurse in their decision-making process to ascertain whether changes to current care are needed. There is also information available about some of the more commonly used stoma accessories and when these may be necessary. With so many stoma-related products available, it can be difficult to know what to use and when; therefore, this article seeks to offer data to aid stoma care in the community.