Ostomy Appliances, Pouching Systems, and Peristomal Skin Management
Systems and selection
Know one- and two-piece systems, drainable, closed-end, and urostomy pouches, flat versus convex barriers, skin barrier rings, paste, powder, protectant film, belts, and adhesive removers. Choose based on stoma type, output, abdominal contour, skin, dexterity, and wear time.
Skin management
Score peristomal skin with DET. Differentiate irritant contact dermatitis from effluent, moisture-associated skin damage, candidiasis (satellite lesions), allergic contact dermatitis, folliculitis, pyoderma gangrenosum, hyperplasia, and granulomas. Clean with water, dry thoroughly, and apply products in the correct order.
Traps: cutting the opening too large; using convexity routinely rather than for retraction, creases, or flush stomas; applying alcohol-based products to denuded skin; using powder without sealing it; excessive paste; fragranced soaps or oils; and applying a pouch to damp skin.
Rule of thumb: the pouch opening should be about 1/8 inch (2–3 mm) larger than the stoma base; empty when one-third to one-half full.
Worked example: denuded, weeping peristomal skin. Clean and dry, apply stoma powder to moist areas, seal with barrier film, dust off excess powder, add a barrier ring, then apply the pouch. Recheck at the next change and address the cause.