Comfort and Care of Ostomies and Feeding Tubes It’s the ... · Ostomy Pearls •Sign up for care...
Transcript of Comfort and Care of Ostomies and Feeding Tubes It’s the ... · Ostomy Pearls •Sign up for care...
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Comfort and Care of Ostomies and Feeding TubesIt’s the Little Things
Susan Hamilton MS, RN, CCRN, CWOCNPediatric Critical Care Nurse Practice Specialist
Boston Children’s Hospital
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Disclosures
No conflicts of interest to declareAll photographs used with permission
I do not endorse any particular product brand which may be mentioned during this talk
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Peristomal Skin Damage Types• Chemical or contact (contact dermatitis): related to ostomy
output acidity, adhesives in pouch products, solvents used on skin
• Mechanical(medical adhesive related skin damage): related to traumatic pouch or tape removal
• Fungal rash: related to antibiotics or moisture
• Allergic reaction: Product allergy
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Contact DermatitisSkin looks reddened and “angry”, may be open
Stool exits at skin level at 7 o’clock
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Contact Dermatitis TreatmentTopical Soaks• Colloidal oatmeal: use if prickly rash present• Astringent: use if open “weepy” skin to dry out
Develop a strategy to protect skin and keep stool off skin
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Contact Dermatitis Skin Care
“Crusting” Technique• Clean site with gentle soap or water• Dry well• Sprinkle powder (stoma or antifungal)• Wipe excess away • “Lock” it in with a skin protectant
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Rings and Things
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4 Days Later
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Medical Adhesive Related Skin Injury (MARSI)
Bond between adhesive and top layer of skin may be stronger than between skin layers
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Prevention of Skin InjuryUse proper skin preparation and proper application and removal of tape
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Fungal Rash
1st Anti-fungal powder peri-stomal skin& anti-fungal ointment to groin area
2nd Skin barrier wipe to “seal”3rd Pectin ring
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Allergies• Skin inflammation that occurs when the skin's
surface comes in contact with a substance originating outside the body
• Often localized, angry red, itchy rash
Allergy to tape border
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Treatment• Change product- if use wafer with tape border switch to no tape border,
sample different brands
Tape border
Manage: 1. Astringent soak x 5 minutes QD for weepy skin 2. D/C paste and powder use pectin ring 3. Steroid or antihistamine ointment to area
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Ostomy Pearls• Sign up for care program of ostomy
supply company to get product samples, online education and support
• Change pouch on a schedule to avoid skin compromise or unexpected leakage
• Own your pouch change/care
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Feeding Tube Skin Challenges
• Pressure Injury• Leakage• Granulation tissue formation• Infection
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Challenge: Pressure Injury
If tube too tight and not
Injury caused by pressure of tube against skin or friction from tube rubbing against skin
Tube too short
Bolster of tube pressed down too tight
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Challenge: LeakageMay be due to inadequate balloon volume,
ineffective stabilization or ineffective gastric seal
• Check FitIs there too much play in tube?Is stoma enlarged?
• Check balloon volume• Check stabilization of tube
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Treatment of Leakage
Contact Dermatitis: from spillage of stomach contents causing skin irritation
Methylcellulose based powders, “crusting”Antifungal ointment (not cream/powder)Wicking/absorbant dressings:
silicone foamhydrofiber dressing
Topical Products
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Stabilize Feeding Tube
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Severe Leakage
Will need to be seen by provider• May need frequent dressing changes • May need to consider tube removal for period
of time• Consider ostomy pouch
to contain drainage
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Challenge: Granulation Tissue• Growth of excess tissue
representing overgrowth of new capillaries which may bleed easy when touched
• Caused by excessive movement of tube in/out of tractØ improper fitØ improper stabilizationØ improper balloon volume
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Treatment: Granulation Tissue
• Stabilize tube• Topical Treatments: (in consultation with provider)Ø Foam dressing containing silverØ Steroid cream (triamcinolone)Ø Silver Nitrate (safety considerations)Ø Surgical removal
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Challenge: Infection (Cellulitis)Cellulitis: Skin infection caused by bacteria
S/S:FeverWarmth, pain +/or tenderness in the affected areaSkin redness or inflammation that gets larger quickly as the infection spreadsTight, glossy, "stretched" appearance of the skin
Treatment: Contact provider (antibiotics likely needed)Outline erythemaWatch for foul smelling or pus like drainage
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Prevention of Cellulitis• Wash your hands before mixing formula. Use clean bowls,
measuring cups, and spoons• If using cans of formula, wash the top of the can before you
open it• Store formula in a clean container • Cover distal end of feeding setup when disconnecting, wash
feed set up with mild soap after use• Change out feed extension on regular basis
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Conclusions
Skin problems can arise at any time
Be prepared
Act quickly
Know your resources