Do you leave skin around the stoma showing when you cut your wafer

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katiesmommy1
Regular Member


Date Joined Aug 2009
Total Posts : 94
   Posted 1/26/2010 1:46 PM (GMT -6)   
Hello again,

The WOC nurse just visited and changed my dd's appliance with me. According to her we should be cutting the hole around the wafer much bigger so that the stoma has room to move / grow. Up until now we were always told the closer to the stoma the better, and that's what we've been doing. We actually had the perfect fit. There was no skin showing around the stoma once the wafer was on.
Today she made me cut the hole so big, that there is skin around the entire stoma showing.
When you prepare your wafers do you leave skin showing or not?

also, I should add my dd is only 3. Maybe it's different with children?? We just got over a really bad skin irritation. Her skin actually seems to be healing and I don't want this to irritate it again.
thanks again,

summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 1/26/2010 4:04 PM (GMT -6)   
no there shouldnt be skin showing. Unless it is different on children. If there is skin showing, then the poo can get on the skin that is showing.
I actually cut mine a tiny bit smaller than it needs to be. And if i do mess up and have some skin showing, the paste kind of fills the hole in for me.
UC for 8 years, before finally kicking its butt and having a permanent ileostomy April 17 2007! 
-I have gone to find myself, if i get back before i return, keep me here-


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 1/26/2010 5:56 PM (GMT -6)   
Francine~is the skin that shows the red/pink area that is directly around the stoma or Katie's actual skin? I wouldn't worry if it is the red/pink skin but would question the decision if, when you change the next time, there are issues.

My reason for asking that is because I was having issues with breakdown and leaks when I measured right up to my stoma...when I increased my wafer opening 1/8" my problems went away. I am an adult and not growing anymore but I am sure Katie will grow for a little while longer!!

Also, are you using anything like an Eakin Seal? If you are, I would think it would keep that little bit of skin healthy and give as she grows.

Just another thought: you could call the appliance manufacturer and get their opinion!

Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 1/27/2010 5:48 AM (GMT -6)   
Francine~ this link is to a brochure from Hollister for pediatric patients...it may be able to help you!
http://www.hollister.com/us/files/pdfs/osted_pcb_pediatric.pdf

also www.uoaa.org has a parent (of children w/ostomies) discussion board and you may find the answer there:)

katiesmommy1
Regular Member


Date Joined Aug 2009
Total Posts : 94
   Posted 1/27/2010 1:27 PM (GMT -6)   
We had to change it again last night and it was irritated again. This time I left a little room near the stoma. (just the pink around the stoma) We don't use any paste or eakin seal b/c when we did her skin got more irritated. I guess I can start using the seal again on top of the wafer. This way it doesn't touch her skin.
I am realizing this whole process is just a trial and error.
I am calling some other companies today and am going to ask for some pediatric samples.
thanks again for all your help,

Chasblah
Veteran Member


Date Joined Feb 2007
Total Posts : 788
   Posted 1/27/2010 8:34 PM (GMT -6)   
The ET nurses told me to cut the hole 1/4 inch bigger than my stoma. But every time I do that, my wear time decreases and the skin gets really irritated. So, I cut it as closely to the stoma that I can and fill in any gaps with paste (even the paste only lasts for a couple of days) I don't make it so tight that the stoma is 'choking'.
I don't think it would make a difference for children. Yes they are growing, but they are growing very slowly. You'll be changing the system every 4-5 days ideally, and measuring each time, which should be enough to account for growth.
i'm sorry about your baby. :(
Chassity
28 yrs. old. married with one beautiful daughter (born 11/20/07)
-diagnosed with severe pancolitis u/c 2002 had total colectomy 12/19/08; emergency surgery due to abscess-had to redo ileostomy and switch to left side 12/25/08; 2/15/09 found blood clot in superior mesenteric vein (prob. from inf. and surgery inflammation)
i only take vitamins now, when I WANT to. :)
(temporary ileostomy....maybe)

"Things turn out the best for those who make the best of the way things turn out."


Shaz032
Forum Moderator


Date Joined Feb 2003
Total Posts : 1246
   Posted 1/28/2010 8:10 AM (GMT -6)   
I would be questioning the stoma nurse - does she not know that when exposed skin gets stool on it, that skin gets sore and irritated?

Cut the wafer as close as you can while still giving the stoma room to move (you'll know if it's too tight - blood flow constricts and the stoma will turn a paler pink colour) and if you use paste or seals, they will cover the exposed skin not covered by the wafer - it's what they're meant to do. To have exposed skin is just asking for trouble.
Ileostomy for 33 years due to UC

Moderator of the Ostomy and Psoriasis Forums

_______________________________________________

I'm not a complete idiot - some parts of me are missing!


Stacey4127
New Member


Date Joined Nov 2009
Total Posts : 16
   Posted 1/28/2010 9:07 PM (GMT -6)   
I have been having this same problem all week. I was cutting my wafers too big on accident and the skin around my stoma became raw and irritated. The ET nurse that came out and looked at my skin and showed me how to put the appliance on correctly cut the hole much, much smaller, it was exactly the size of the stoma. My skin is already starting to heal. I agree with everyone else on this one.
1994 - exploratory laparoscopy
1998 - emergency laparotomy ovarian cyst
1999 - emergency laparotomy removal of left ovary and endometriosis
2000 - total hysterectomy - laparotomy
2001 - laparotomy removal of mass which was adhesions
2001 - laparotomy due to complications of previous surgery
2003 - laparoscopy removal of adhesions
2006 - laparoscopy removal of adhesions
2009 - 12/17/09  laparospic subtotal colectomy with anastamosis and removal of adhesions
2009 - 12/26/09 - open laparotomy due to leak from subtotal colectomy - ileostomy placed
2009 - 3/2009 [ REVERSAL SCHEDULED]


pinkfishbeach
New Member


Date Joined Jan 2010
Total Posts : 3
   Posted 1/29/2010 8:46 PM (GMT -6)   
If you have an ileostomy, the stool is much more acidic than a colostomy; therefore, it will eat up the exposed skin around the stoma. Cut your wafer close to the stoma, but not touching the stoma, as you do not want it to cut into the stoma. If the stoma is new, it will continue to shrink post-operatively for several weeks. You will need to measure the stoma with the measuring guide that comes with your kit and then cut out the appropriate size from the wafer. Be sure to run your finger around the cut out edge of the wafer to ensure there are no sharp edges that could poke into and irritate your stoma. Once your stoma shrinks down some and the size remains the same, you can purchase pre-fit/pre-cut wafers. They are more expensive but quicker. For skin breakdown around your stoma, and for cleaning your stoma..be sure to never use soap on that skin. Soap can irritate and will also cause the wafers/adhesives to not stick as well. Only use water and paper towels or soft cloth. To help irritated skin heal, clean skin with water and paper towel only. Pat dry. Layer Stoma Powder and 3M no-sting skin barrier spray, starting with the Stoma powder. Dust a light coating on dry skin, then spray no-sting skin barrier to cover powder. Repeat layering a couple of times then proceed with applying wafer. The layering of those two things will allow the skin to heal underneath the wafer. You can also try just using the 3M no-sting skin barrier and it will help. Use Eakin to fill in any gaps between wafer and stoma.

damagedgoods41
Regular Member


Date Joined Sep 2009
Total Posts : 377
   Posted 1/29/2010 9:40 PM (GMT -6)   
hello Katiesmommy1,
Im sorry for ur daughter going through all of this. Ive had my ileostomy for nearly 10 years now and i use a two piece system by hollister. When i put my wafer-baseplate on i cut it so it's completely snug tight around the stoma because if i dont i know that i will have skin irritation and constant leakage. So when you cut the wafer really make sure it fit's snug and there is no skin showing at all and you will find all the troubles will go away. Also look at trying a deep convexity wafer with an eakin seal aswell. Yes it is trial and error on the mostpart but ur stoma nurse sounds like she doesn't really know how to apply things properly. I wish you all the luck in the world. Remember go with your gut and not what ur stomas nurse tells you ok!!!
 
sincerley,
 
Beverley............
 
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