Stoma Appliance Research Articles

Stoma care appliances: an overview

A core aim in stoma care is to ensure the appliance (also known as a pouch or bag) establishes and maintains a secure seal, and so identifying the appropriate appliance for an individual ostomate is vital. This article presents a summary of the latest available range of stoma appliances on the market. There are two types of pouching systems: one and two piece. There are three main types of stoma appliances: closed, drainable and urostomy. Stoma care nurses need to be well informed about stoma appliance innovation, so that they can advise patients on what appliance is best for them. It is also the role of a stoma care nurse to educate patients on the technique for appliance application. If a patient is wearing an inappropriate appliance or they have a poor application technique, this can result in stoma complications, such as leakage and/or sore peristomal skin.

EP.FRI.50 Morbidity of presumed temporary loop de-functioning stomas in patients with colorectal cancer

Abstract Objectives The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma. Methods This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site. Results 147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients. Conclusion Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.

163 Morbidity of Presumed Temporary Loop De-Functioning Stomas in Patients with Colorectal Cancer

Abstract Objectives The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms, or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma. Method This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site. Results 147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients. Conclusions Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.

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.

Novel stoma appliances to minimise complications and improve patient outcomes.

Stomas are created for a number of reasons and, if they are formed without the opportunity for preoperative care and consideration, such as siting, stoma care needs can be more complex in the long term. Patient quality of life can be negatively affected by the incidence of stoma related complications, such as leakage or sore skin. A new range of products, Aura Plus, distributed by CliniMed Ltd in the UK, were evaluated on more than 200 patients with a stoma and assessed for comfort, ease of application, security and leakage. Case studies highlight positive patient outcomes following the use of Aura Plus, and demonstrate how Aura Plus can benefit patients experiencing different needs with their stoma care, such as leakage, peristomal skin complications or a parastomal hernia.

Management of Ostomy-Related Varices.

Management of Ostomy-Related Varices.

Using a novel breathable silicone adhesive (Sil2 technology) in stoma appliances to improve peristomal skin health: answering the key questions.

Fiona Le Ber answers some of the questions that stoma care nurses may have regarding this novel silicone adhesive based technology, which helps to avoid medical adhesive related skin injury (MARSI) and moisture-associated skin damage (MASD). Whereas hydrocolloid stoma appliances absorb moisture, this has a non-absorptive method of moisture management that prevents peristomal skin becoming damp and excoriated.

Developments in silicone technology for use in stoma care.

Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit transepidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal transepidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.

Using a novel breathable silicone adhesive (Sil2 technology) in stoma appliances to improve peristomal skin health: answering the key questions.

Fiona Le Ber answers some of the questions that stoma care nurses may have regarding this novel silicone adhesive based technology, which helps to avoid medical adhesive related skin injury (MARSI) and moisture-associated skin damage (MASD). Whereas hydrocolloid stoma appliances absorb moisture, this has a non-absorptive method of moisture management that prevents peristomal skin becoming damp and excoriated.

Developments in silicone technology for use in stoma care.

Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit transepidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal transepidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.

3D-Printed Ostomy Flange Stabilizer.

One of the coauthors with tetraplegia (quadriplegia) and a colostomy invented an ostomy flange stabilizer to act as a temporary backplate and aid in pouch changes. In an interactive design process, a 3D-printed ostomy flange stabilizer device was created. The resulting device can be adapted to 3 standard stoma appliance sizes. The stabilizer is reversible, allowing right- and left-handed people to use it on right- or left-sided stomas. Anyone with a 3D printer can print this device from an open-access Web site. This device may be of use to many with ostomies and especially those with impaired dexterity.A 3D-printed ostomy flange stabilizer is described. 3D printing allows patient inventions to be disseminated without commercialization.

Using a novel breathable silicone adhesive (Sil2™ technology) in stoma appliances to improve peristomal skin health: answering the key questions.

Fiona Le Ber answers some of the questions that stoma care nurses may have regarding this novel silicone adhesive based technology, which helps to avoid medical adhesive related skin injury (MARSI) and moisture-associated skin damage (MASD). Whereas hydrocolloid stoma appliances absorb moisture, this has a non-absorptive method of moisture management that prevents peristomal skin becoming damp and excoriated.

Preventing prescribing of antibiotics for peristomal moisture-associated skin damage (P-MASD)

People living with a stoma may, at some point in their stoma journey, experience peristomal skin complications (PSCs). The majority of PSCs occur as a result of leakage of stomal output onto the peristomal skin, which often results from poor templating or selection of stoma appliance. PSCs typically manifest as hot, red, sore and weepy skin. The symptoms can be misinterpreted as signs of infection, and, as a consequence, professionals may incorrectly prescribe a systemic or topical antibiotic. This is especially problematic, as overuse of antibiotics has been leading to greater bacterial resistance to these treatments, and it is increasingly emphasised that they should not be prescribed unless absolutely necessary. However, an experienced clinical nurse specialist in stoma care should be able to correctly diagnose a PSC, prescribe the appropriate treatment and resolved the problem quickly, without the use of antibiotics.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

Factors influencing the incidence of peristomal skin complications: evidence from a multinational survey on living with a stoma

Leakage of stomal effluents underneath the baseplate or inappropriate removal of stoma appliances can cause peristomal skin complications (PSCs), which are known to have many negative implications for people with a stoma. While numerous studies have examined the causes of PSCs, less is known about what drives the risk of a PSC developing. To address this gap in knowledge, the largest multinational survey to date was conducted, including 4235 people with a stoma on four continents and in 13 countries. The survey revealed that, besides leakage, other factors, such as age, gender, time since surgery and type of stoma, also drive the risk of PSCs. The survey also revealed that having a PSC resulted in greater use of stoma accessories and more frequent contact with health professionals, increasing overall healthcare costs. Collectively, the survey results reveal a need for more awareness on the risk factors for PSCs, which subsequently could have a positive effect on healthcare spending.

Developments in silicone technology for use in stoma care.

Soft silicone's flexibility, adhesive capacity and non-toxic, non-odourous and hypoallergenic nature have made it an established material for adhesive and protective therapeutic devices. In wound care, silicone is a component of contact layer dressings for superficial wounds and silicone gel sheeting for reducing the risk of scarring, as well as of barriers for incontinence-associated dermatitis. Regarding stoma accessories, silicone is established in barrier films to prevent contact dermatitis, adhesive removers to prevent skin stripping and filler gels to prevent appliance leaks. Until recently, silicone has not been used in stoma appliances flanges, as its hydrophobic nature has not allowed for moisture management to permit trans-epidermal water loss and prevent maceration. Traditional hydrocolloid appliances manage moisture by absorbing water, but this can lead to saturation and moisture-associated skin damage (MASD), as well as increased adhesion and resultant skin tears on removal, known as medical adhesive-related skin injury (MARSI). However, novel silicone compounds have been developed with a distinct evaporation-based mechanism of moisture management. This uses colloidal separation to allow the passage of water vapour at a rate equivalent to normal trans-epidermal water loss. It has been shown to minimise MASD, increase wear time and permit atraumatic removal without the use of adhesive solvents. Trio Healthcare has introduced this technology with a range of silicone-based flange extenders and is working with the University of Bradford Centre for Skin Sciences on prototype silicone-based stoma appliance flanges designed to significantly reduce the incidence of peristomal skin complications, such as MARSI and MASD. It is hoped that this will also increase appliance wear time, reduce costs and improve patient quality of life.

A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study

BackgroundWe hypothesise that a physical activity (PA) intervention will improve the quality of life (QoL) of people with a stoma. A feasibility study of the intervention and trial parameters is necessary to inform a future main trial.MethodsParticipants received a weekly PA consultation by telephone, video conferencing, or face-to-face for 12 weeks with a PA instructor who prescribed physical activities and supported participants by addressing stoma-related concerns and using behaviour change techniques. A feasibility study of the intervention and trial parameters was conducted in three UK sites using mixed methods.ResultsThe number of eligible patients consenting to the study was 30 out of 174 (17%). Most participants were female (73%); 73% had an ileostomy and 27% a colostomy; mean time since diagnosis was 6 months. A total of 18 (64%) participants completed pre- (baseline) and post-intervention (follow-up) measures. Results show an improvement on all scales measuring QoL and disease-specific fatigue. The median PA consultation rate per participant was eight sessions. Participants reported completing 75% or more of the prescribed PA each week. Eight stoma-related themes were identified from qualitative interviews: fear of hernia, bending down, fatigue, pain, prolapse, surgical wounds, stoma appliance, and stigma. The intervention appeared to address these issues.ConclusionThis feasibility study demonstrated that a novel manualised PA intervention for people with a stoma is safe, feasible, and acceptable, and shows promise for improving outcomes. However, difficulties with recruitment will need to be carefully considered to ensure the success of future studies in this area.Trial registrationISCTN, ISRCTN58613962; Registered 14/9/2017.

PMD62 THE ASSOCIATION BETWEEN STOMA RELATED COMPLICATIONS AND STOMA APPLIANCE PRESCREPTION SPEND

To identify the association between stoma complication and the prescription spend of stoma related appliances. This is a retrospective cross-sectional observational study investigating the association between stoma appliance consumption and faecal leakage from the stoma pouch (FL), peristomal skin complications (PSC), social concern (SC) and ballooning/pancaking (BP). Data is collected via a community-based patient support programme in the UK. We use multivariable regression with/without logarithmic transformation of the cost variable to model the absolute and relative association to costs of bags and plates and other reimbursed supporting products, separately and combined. 2713 patients from 31 clinical commissioning groups were included from 2016 to 2018. Mean age was 69.9yr, 47% were female. 25.1% had FL, 23.6% (PSC), 12.2% (SC) and 9.3% (BP). The mean total monthly cost of stoma appliances was £200.01 (£158.23 for bags/plates and £41.84 for supporting products). The parameter estimates (p-values) comparing patients with/without complications controlled for confounders for FL, PSC, SC and BP in the analysis of non-transformed monthly costs of bags/plates are £24.83 (0.002), £0.17 (0.973), £25.16 (<0.001) and £15.53 (0.025), respectively. The estimates in the log transformed analysis are 0.137 (<0.001), 0.048 (0.104), 0.157 (<0.001) and 0.104 (0.011). In the analysis of costs of supporting products, the estimates are £12.61 (<0.001), £2.25 (0.377), £10.58 (0.001), £5.86 (0.096) in the non-transformed analysis are0.226 (<0.001), 0.048 (0.394), 0.100 (0.150) and 0.124 (0.114) in the log transformed. The model analysing the non-transformed costs of all stoma products has the following parameter estimates, £35.55 (<.0001), £2.41 (0.697), £35.74 (<0.001) and £21.39 (0.013), respectively and 0.189 (<0.001), 0.011 (0.716), 0.126 (0.001) and 0.098 (0.020) in the log transformed analysis. FL, SC and BP are all associated with increasing stoma appliance related prescription spend.

A novel topical therapy for resistant and early peristomal pyoderma gangrenosum.

Peristomal pyoderma gangrenosum (PPG) is an under-recognised and difficult condition to treat. We describe a case series using a novel topical combination therapy that promotes wound healing and allows for adhesion of the stoma appliance. A crushed oral prednisolone tablet mixed with Stomahesive Protective Powder (ConvaTec) was applied topically to seven patients with PPG and resulted in pain relief and wound healing in six of seven patients. Only one patient experienced recurrence. The novel topical therapy we describe is cost-effective, readily available, and easily applied in any inpatient or outpatient setting.

Experiences of support garments following bowel stoma formation: analysis of free-text responses in a cross-sectional survey

AimTo explore the experiences of support garments when adjusting to bodily change following bowel stoma formation.DesignThematic analyses of free-text responses in a cross-sectional survey of the stoma population in 2018.MethodsFree-text...