- Try using adult ostomy products, even on infants. The infant projects often don't hold up, especially for watery output. Many families switch to the adult products when their kids are 3-4 months.
- Cotton balls in the bag to soak up liquid (see TJ and Ellie Brogan notes below for details) -- they extend wear time, and keep leaks much more manageable (and safe) when they do happen. See also ostomy-gels, which dissolve to form a gel with ostomy output.
- Eakin cohesive seal extends wear time by sealing the area between the skin and the ostomy appliance.
- Stretchy Bandages (aka Hernia belts) were the biggest innovation for MaxMunakata -- without them his barriers last less than a day, with them his barriers last up to 6 days (see notes below for details).
- Several families have found that powder and skin protectant wipes actually reduce wear time, and that bags work better without them.
- Microwaved sock of rice to warm wafer before and after application.
- Tape or tegaderm around the barrier (instead of stretchy bandages, or in addition): this can help it stay on better, and protect from pee or leaky g-tube (see Austin Rath and Ellie Brogan notes below). However, it can also potentially cause increased moisture and stool buildup under the barrier -- every time MaxMunakata has tried this, the skin condition under the barrier has deteriorated. YMMV (your mileage may vary).
- Leaking g-tubes and/or urine can weaken the adhesive of the wafer, especially the "cloth" type of wafer, leading to bag leaks. Cut a medium sized Tegraderm dressing into 4 1" stips. Frame the wafer with the Tegraderm so the outer cloth portion of the wafer and about 1/4" of skin is covered by the tegraderm.
- The wound/ostomy specialist at your hospital can provide products and techniques to try. Companies are also happy to provide free samples.
- Tubegauz is a better choice than tape to keep gauze snug against the mucus fistula to absorb discharge. Your hospital may keep it in stock already for burn patients. An Internet search for “Tubegauz elastic net” will find many suppliers.
- To change an ostomy bag as quickly as possible, make up five or six “kits” at a time with everything you need to make a single change in a Ziploc bag: the bag itself, a pre-cut skin barrier, pre-cut gauze, a packet of detachol, a pre-cut strip of Tubegauz, etc. Making the change go as quickly as possible reduces stress on the patient (and caregiver) and reduces the likelihood of something coming out of the stoma during the change.
Types of barriers, bags and paste
- ColoPlast: http://www.us.coloplast.com/ECompany/USMed/Homepage.nsf
- Hollister: http://www.hollister.com/us/ostomy/consumer/default.asp?ugid=3
- ConvaTec: http://www.convatec.com/
- Other Products
- Friends of Ostomates Worldwide: http://www.fowusa.org/newsite/page.php?page=home a volunteer-run, non-profit organization providing ostomy supplies and educational materials to ostomates in need around the world.
Waterproof ostomy protector for swimming.
Please share your secret recipes for making this chore easier and less painful..
Updated 4/07/08: Following suggestions from the yahoo short bowel syndrome group, we have switched from our old system to a much simpler system that seems to be working well. After prepping materials and starting a video for Max to watch, we:
1) Lay a warm wet washcloth over the stoma and surrounding skin for a couple minutes.
2) Gently pat off any residue from the skin.
3) Fan the area until very dry, keeping a tissue over the stoma to catch any output.
4) Apply Eakin cohesive seal, shaped to fit snugly around ostomy.
5) Apply skin barrier with bag attached. We use Coloplast products with convexity that work well with liquid stool and a retracting stoma -- 3 different kinds of skin barriers (Product #s 11011, 14243, and 14281) and one kind of bag (#2156) that works with cotton balls.
6) Press well to get a good seal, then hold a hand over the barrier for a minute to warm it.
7) Put a stretchy bandage around the torso to help hold the bag on. We use spandex bandages, after being warned that ace bandages have latex and might lead to allergies with prolonged exposure. Following AustinRath's suggestions below, Yuko's Mom sewed some velcro on the bandages -- makes things much easier. We cut a small hole in one end of the bandage -- as small as possible while still allowing you to get it around the flange. Loop the hole around the plastic flange (so it sits between the flange and the brown wafer).
8) Fill the bag with cotton balls to soak up liquid and extend wear time. Clip the bag.
To empty the bag with cotton balls (following Abby Brogan's suggestions), we use manual peristaltic action and squeeze them out onto a ziploc baggie and weigh with a scale to determine output, 1 gram = 1cc. Super jumbo cotton balls seem to be the biggest size. Works great!
I've had lots of leaking bags. As a result I've tried many different products (all three companies, including Hollister, Convatec and Coloplast, are all very generous in sending samples, so ask to try lots of different products) and methods, almost all resulting in bag changes approximately every 24 hours (sometimes 3-4 per day). I recently tried Yuko's method with the ace bandage and had great results - 3 days! Austin didn't seem bothered to be wearing it and his nurse said it's completely safe - just like a thick waist band.
I am currently using urostomy products instead of ostomy products since Austin's outputs are so liquidy. These products also seem to work better with the ace bandage. This is the Convatec wafer I'm trialing (designed to handle liquid outputs of a higher volume):  and this is the bag I'm using:  Coloplast also has a product (ref. #1789), which also is a urostomy product that I think would work well.
I've had some additional luck using the Hollister Adapt barrier rings (ref# 79520) and gotten up to 3 days (without the ace bandage when adding that product). I use Allkare adhesive remover (Convatec)to remove wafers, gold colored dial soap to wash the skin (a necessity if you're using adhesive remover), followed by Stomahesive powder on any broken skin and Cavilon Barrier Film (3M) over the entire skin. I use Stomahesive paste in Austin's belly button, which is close to his stoma and contributes to leaks, and around the opening of the wafer. To warm up the wafer before application (this is suppose to improve wear time), I microwave a home made "bean bag" of rice for about 25 seconds and then put it on top of the wafer (Yuko pointed out that you can avoid sewing by using a sock and tying a knot). After the wafer is warm, I then apply it to Austin's skin. I've found the Medipore water proof, hypoallergenic tape to be helpful in extending bag life. Tegaderm over the cloth portion of the wafer helps to extend wafer life by preventing the adhesive from breaking down from urine or g-tube leaks.
For bag leaks, which often seem to occur when Austin is wearing a new outfit or something that is light colored, I've found TotallyToddler pre-treat (http://www.totallytoddler.com/) to be a life saver (Baby's R Us carries it). I've had white shirts covered in stool from a bag leak that comes out clean. Just pretreat with totally toddler and let it soak for 10-15 minutes and then wash as normal. I think it actually works better than bleach.
Austis is always trying to pull off his Broviac dressing and central line tubing during bag changes. One thing that I've found helpful is to cut off a little undershirt so it falls just below the dressing. I put the little mini shirt on when doing bag changes and he pulls at the shirt instead of the dressing and line.
Before our daughter began solids, she had quite the liquidy stool. A nurse suggested we use 2 cotton balls in the bag. It worked wonders for us. We were able to get an extra 3-4 days out of each bag. At every diaper change, we replaced the cotton balls with clean ones.
This is the recipe we use and it has worked well for the past three months, but we will see what we use down the road.
First, we clean the skin with warm washcloths to remove any adhesive and to clean up any stool. If anything doesn’t come off easily then we let the area soak under a warm wet wash cloth for a few minutes and that usually does the trick. Once the area is clean we thoroughly pat the area dry. We also have started using SafeN'simple Stoma wipes. They are very mild and the only adhesive remover that Ellie's skin can tolerate.
To protect the skin around the stoma we put down alternating layers of Cavilon No Sting Barrier and stoma powder right around the stoma. The no No Sting Barrier and powder will make the bag fall off if you put it where the adhesive for the bag is so keep it limited a very narrow ring right abound the stoma. The last layer should be No Sting Barrier. We have found that No Sting Barrier in sponge form works really well.
We use a two part system that works very well for us. The base is “Esteem Synergy” ostomy base, the bag is a Pouchkins bag with adhesive seal. Right now we are just putting the bag on her skin with some no sting. But we have also used Cohesive Ring Seals. They work great and can make a bag stay on for a few extra days.
1. Warm heat rice heat pad (cloth bag filled with Rice) in microwave for 1 minute.
2. remove sticker from base and place on heat pad with the sticky side up.
3. remove both top and bottom stickers from the cohesive seal
4. gently, without touching the sticky sides, stretch the hole of the seal to be the same size as the hole in your base and place on sticky side of base.
5. Remove old and ostomy bag
6. lay wet warm washcloth on skin around ostomy allow it to sit for a minute or two
7. gently wipe off any old adhesive or waste from skin
8. once area is clean, use Stoma wipe to remove any old adhesive. Then wipe area again with another wet washcloth.
9. dry area with dry wash cloth, watch for oozing ostomy!
10. once skin is dry using No sting sponge wet a small area just around the ostomy
11. apply a thin line of powder around the ostomy on the wet area
12. using your finger smear the powder to a level ring around the ostomy
13. wet the powder to saturation with the No Sting sponge.
14. Apply the base with the seal to the skin
15. Put your finger inside the bag and genitally move the lips of the soma around and push down on the base to make sure the base is in complete contact with the skin. Then push down on the adhesive ring of the bag to make sure it is secured to the base.
16. Put the warm rice bag on top of the bag and allow it to sit for a few minutes. Then repeat the step above.
That is the bag change. It usually lasts us around 3 days. Ellie has a very high output averaging about 3 cc/Kilo/HR or so we fill her bag with cotton balls. They absorb all the liquid as she produces it so when it comes time to empty the bag we just remove the cotton balls and don't have to worry about liquid. It results in much less leaking and it also pulls all the liquid away from the stoma itself there by increasing the life span of the ostomy bag and protects her skin.
I manipulate the balls out of the bag using the bag it's self. We empty the balls into Zip lock bags, this cuts down on the amount of stool that is sitting around and stops the trash from smelling too much. We then weigh the cotton balls to determine the amount of output. We get our cotton balls from our medical supply company and that has saved us a ton of money. If you have any questions email me at Abbybrogan@hotmail.com
Laney from yahoo Short Bowel Syndrome Group
I find that Ilex cream is good for protecting any irritated skin I might get around my stoma. An ET nurse told me that it is the only cream or ointment that really works underneath ostomy barriers without ruining the seal. I find stoma paste really is not helpful if irritation has already developed. The other solution that my first ET taught me is the layering of stoma powder with barrier film...and that is just kind of a pain to me, and not as good as the Ilex cream, for me.
My stoma extends beyond the skin only about an inch at most, and sometimes flush with the skin (depending on peristalsis)...that contributes to skin irritation and short wear time. So, I use a convex insert with my appliance to help press the surrounding skin down around the stoma, thus making the stoma protrude a bit more. I also use an Eakin Seal to add more convexity, and to help absorb the bit of output that seeps down the stoma still.
Laura from yahoo Short Bowel Syndrome Group
Try skipping the powder and the wipes. I, along with some other parents, have found that this actually makes the life of the wafer and bag shorter (the products that are supposed to make it stay on longer actually don't) Make sure that you don't use any fabric softener in your laundry (washcloths that you use to clean the area or towels) or soaps that have any oils or lotions. Ivory soap is best for cleansing the surrounding skin. Try using a barrier ring and breaking it, then wrap it around the stoma very securely. You can use paste first to make sure there's no open space before putting the ring on, too. The hair dryer idea is a good one, we use that too sometimes when he's just gotten out of the bath. You can also make a small cloth bag, fill it with rice, and use it everytime you need to replace the bag. What you do is put it in the microwave until it's very warm and then use it to warm up the bag. Personally, I just stick the bag in my shirt to warm it up while I'm cleaning up Tyler and by the time he's ready for the bag to be put on it's nice and warm. PS I have a whole section on Tyler's website about keeping bags on.
picture of yeast on the skin around the stoma. Nystatin powder will treat this.