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Stoma Care

What is peristomal skin damage?

  • A stoma (also referred to as an ostomy) is an opening made on the front of the abdomen during surgery, which diverts the contents of the gastrointestinal or genitourinary tract outside of the body, and is secured to the skin.

    Stomas are red and moist in appearance, and can stick out from the skin by a few centimetres, although some stomas may be flush to the skin. Stoma sites are rich with blood vessels and can bleed easily if knocked or bumped, but otherwise shouldn’t cause the patient any pain or discomfort.

    Peristomal skin damage refers to injuries that occur around the stoma. While there is much focus on preventing pressure ulcers and other ailments, attention should also be given to preventing all types of avoidable skin damage, including peristomal skin damage.


How does peristomal skin damage develop?

  • The skin surrounding a stoma can be damaged either by adhesives, or from exposure to urine and faeces as a result of stoma pouch leakage.

  • Peristomal Irritant Contact Dermatitis (PICD)

    PICD occurs due to exposure of the skin to urine and faeces. Over time the stratum corneum becomes softer, more permeable and and skin pH moves away from its normal acidic pH range, necessary to maintain skin barrier and repair functionality, into an alkaline state. Proteolytic and lipolytic digestive enzymes are present in large quantities in liquid faeces and cause direct damage to skin through inflammation. This is similar to the damage caused by Incontinence Associated Dermatitis (IAD). faeces from the small intestine (e.g. from an ileostomy or jejunostomy) are rich in these enzymes.

  • Medical Adhesive Related Skin Injury (MARSI)

    When an adhesive is removed from skin, layers of epidermal cells are also removed. If multiple layers are removed and the skin has not had sufficient time to regenerate new epidermis, the stratum corneum becomes damaged, with deeper epidermis exposed and barrier function compromised. Skin stripping is the term used to describe delamination (separation) of layers of the epidermis or detachment of the entire epidermis from the dermis. This is most commonly associated with:

      

    • Fragile elderly skin where the epidermis is poorly anchored to the dermis
    • Use of aggressive adhesives
    • Use of tackifiers such as benzoin tincture
    • Improper removal of adhesives
  • Tips for preventing peristomal skin damage

      

    • Inspect the pouch at least twice per shift
    • Empty a pouch when it is no more than a third full, to prevent unplanned detachment from skin
    • Abdominal hair should be clipped
    • Remove and reapply a new pouch two to three times per week at regular intervals, if the skin barrier has separated from or lifted from the skin or if you can see or feel faeces/urine along the edge of the pouch or on the surrounding skin
    • Apply 3M™ Cavilon™ No Sting Barrier Film before pouch application
    • Don’t fix a leaking pouch with tape – this only increases the chances of developing skin irritation as faeces/ urine is trapped against the skin
    • Always consult a stoma nurse specialist for guidance on appliances and peristomal concerns

Peristomal skin care

  • It is essential that the skin surrounding a stoma site is protected from the potentially irritating and excoriating effects of bodily fluids and adhesives.

    Applying 3M™ Cavilon™ No Sting Barrier Film to a peristomal site provides long-lasting protection against enzymes and other harmful elements often present in intestinal contents or urinary/faecal effluent1. Cavilon no sting barrier film also protects the skin against adhesive trauma2 caused by the frequent application and removal of stoma pouches and flanges. Cavilon no sting barrier film is ideal for use around colostomy, urostomy, tracheostomy, and gastrostomy sites. It can also be used on excoriated or broken skin.

    Cavilon no sting barrier film is available in convenient and discreet 1ml wipes. Each easy to use wipe offers gentle, yet effective protection with an alcohol-free formula for delicate peristomal skin. Cavilon no sting barrier film can be used during appliance change to protect against adhesive related skin injury, and to prevent and treat sore skin.


References

    1. Jones D, Powell G, Burton J, Marshall J, Edwards A. (1999) An effective barrier against the ravages of proteolytic enzymes on peristomal and perianal skin. Presented at the RCN Gastroenterology and Stoma Care Nursing Conference, Eastbourne 1999.
    2. Arrowsmith M, Schuren J (2005) Laboratory Studies and general characteristics of Cavilon skin care products. 3M data on file.

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