Thanks- good suggestions. @pluot- I was taught and have been doing the barrier ring right onto the wafer. When I remove the old wafer it seems that the barrier ring has turtle necked nicely, but I see your point about switching to whatever I have not been doing, in case there was even the slightest gap. Do you roll the barrier ring into a rope that you collar around the base of the stoma, or do you just stretch a piece of intact barrier ring around the stoma as some are taught to do? I gather some people even put an entire ring around as is like a donut, with the hole stretched... My first WOSn's told me that this can raise the wafer up too much and interfere with the seal but it seems there are a lot if variations in what is taught as best practice.
Oh boy, I am definitely "some people" -- I use a whole barrier ring "like a donut" and slowly stretch it until the inner ring is about
the size of my stoma, then lay it directly on my skin. If you jump ahead to 1:07 in this video you can see exactly how I do it: www.youtube.com/watch?v=26rpN2ECnQE
I've never had an issue with it raising the wafer too high. My stomas have stuck up about
3/4" like yours so I don't think it would cause an issue. If I couldn't afford to use so many barrier rings maybe one of the other methods would work for me, but insurance provides and this has never caused a problem so I stick with it
Skin seal wipes = no sting skin prep? I use it with most changes just out of habit. I've done changes without it and it was fine too, but obviously you need it if you are crusting powder over areas of irritation. There's no need to re-crust over irritation that you can't see (ie if it's still covered by old powder). PS, as the irritation heals, if it reaches a point where it's ALMOST normal, but maybe still a little red or something, rather than crusting you can dust on a little powder, let it sit for 15 seconds, then wipe it all away with a piece of gauze or paper towel. A small amount of powder will be left behind in your pores that will help soak up moisture and protect the skin but won't require actual crusting. With the weather getting warmer and as I become more active I am going this route for all of my peristomal skin (dust on powder, wipe away 'completely') to absorb excess moisture and try to head off any fungal infections.
dx'ed UC pancolitis 5/12
past meds: asacol hd, VSL#3, apriso, rowasa, xifaxan, 6mp, cortifoam, pentasa, cimzia, canasa, butyrate, flagyl, cipro, prednisone, remicade, methotrexate, cholestyramine, cortenema
current meds: none!
step one: colectomy, end ileo 1/16/13
step two: j-pouch construction, loop ileo 5/1/13
step three: takedown 7/31/13