I have just had surgery and now have an ostomy. My ET sent me home with just flanges, pouches and paste. My HomeCare nurse says I need more supplies like stoma powder, adhesive remover and skin wipes. I’m confused: what products should I be using?
The basic necessities of ostomy care include the products your ET sent you home with: the flanges, pouches and paste. The extra supplies your Homecare Nurse is referring to are called accessories. There are many accessories available for ostomy care, and not all of them are either necessary or required for your care. Below are a few of the common accessories and their suggested uses:
Stoma paste has a thick, toothpaste-like consistency and is essentially a different format of the materials that make up the barrier component of your flange. While the label of ‘paste’ implies features similar to glue, stoma paste is actually more akin to caulking. Paste is most frequently used at the edge of the inner opening of your flange, as a means to protect exposed skin from your stool. Your ET will have taught you to ensure that the flange opening is 1/8-inch (3-4mm) larger than the base of your stoma. The paste fills in this gap to protect your skin. You can also use paste to fill in minor creases or gullies to your peristomal skin, preventing the tracking of stool and leakage of your pouch. Not everyone with a stoma requires paste. If you have a colostomy with pasty to formed stool, you could consider eliminating the use of the paste. If you have an ileostomy, your ET nurse may recommend the use of paste depending on the type of barrier that you are using.
Stoma powder is a finely ground format of the barrier component of your flange. The powder has limited absorptive capacity, and it is most often used to treat peristomal complications such as excoriated (irritated) skin. The powder is sprinkled in a thin layer over the affected area, and then must be sealed in with a barrier wipe (these will be discussed below). If used alone, the powder will prevent your pouch from sticking to your skin. Powder is not required for routine ostomy care as it is essentially the same as the barrier of your flange, so adding it to your care regime when there are no complications, offers no benefit. Routine use of this item only adds to the cost of your care (adding more products) and increases the time needed to complete regular changes.
Various wipes are also available for ostomy care. You can use adhesive-removers for your ostomy care but, as in the case of powder, routine use is not necessary. Gentle removal of your flange, by using your fingers to push your skin away from the back of the barrier, is usually sufficient to help take your old pouching system off. Adhesive removers are helpful in removing the build-up of adhesive and fabric fibres that commonly gathers at the edge of the flange. If you are using removers, it is very important to ensure that you clean your skin well after use and before application of your new pouching system. Any residue remaining on your skin from the wipes may result in poor pouch adhesion, and may contribute to skin sensitivities.
Other types of wipes that can be used are called skin protectors; these have a different use. These wipes have a liquid that, when applied to your skin, dries very quickly to a thin film providing a thin barrier or protective layer between your skin and the adhesive component of your pouching system. However, as ostomy pouches are designed to be gentle to your skin and to prevent trauma, routine use of the protective wipes is generally not required. The wipes will not increase the adhesion of your pouching system. Wipes can, in fact, decrease the adhesion of the the barrier by preventing the “flow” of the barrier into the natural crevices of your skin.
These wipes should be used if you require ostomy powder for your care: the powder must be sealed with the wipe to allow the pouching system to adhere to your body. For individuals with fragile skin (such as the elderly or those taking steroids) the thin film may provide additional protection to the skin on pouch removal. A word of caution: the majority of these protective wipes contain alcohol and can cause temporary stinging/burning if applied over broken skin. There is one alcohol free version available from 3M® called Cavilon™.
Ostomy belts are another commonly used accessory. Many varieties of pouches will have belt tabs on either the flange or the pouch, placed at the 3 and 9 o’clock positions. These look like little ears and allow an elastic belt to attach to your pouching system. For some individuals, belts are a necessary part of care. Belts may help to pull the pouching system closer to the body or help to accentuate convex appliances. Some individuals prefer to use belts during activities such as sports or heavy labour, as belt use can offer a sense of security. As with the other accessories, not everyone requires a belt and an ET can help you to determine if one is necessary.
There are many more products available for ostomy care. The variety of supplies can be overwhelming, and misinformation about their intended use and absolute need could further complicate matters. Ideally, ostomy care should be simple, using the fewest number of products possible. For some patients, additional products may enhance care; however, multiple accessories can also increase the cost and time required for your routine.
One further thing to consider regarding accessories: some products may cause sensitivities and the use of a multitude or products may make it difficult to discern which one is the source of irritations. Your ET can assist you in managing all aspects of your ostomy care and help you to determine if accessories are right for you.