CLINICAL UPDATE
Stoma care in the community Jennie Burch
Enhanced Recovery Nurse Facilitator, St Mark's Hospital, Harrow, Middlesex
Stomas Stomas can be permanent or temporary. Temporary stomas are closed or reversed in a subsequent operation, months or years after the stoma is formed. The colostomy is formed from the large bowel or colon. In appearance, the colostomy is red, round or egg-shaped and ideally minimally raised above the abdominal wall. A colostomy will pass flatus and formed faeces into a closed stoma appliance or bag (Black, 2011). Colostomy appliances are replaced every few days to several times daily—commonly once per day. An ileostomy is formed from the small bowel or ileum. In appearance, the ileostomy is red, round or egg-shaped and is ideally formed with a small 25 mm spout. An ileostomy will pass flatus and loose faeces into a drainable appliance fastened with a Velcro-type fastening. The appliance requires emptying 4–6 times daily and is usually changed on a daily or alternate-daily basis. Finally, urostomies are usually formed from the ileum, giving the name ileal conduit. It is less
Abstract
There are over 100 000 people in the UK with a stoma. For nurses working within the community and dealing with a variety of conditions, making a decision regarding the most appropriate stoma appliance to use on ostomates can be a challenge. This article gives a general overview of stomas and stoma appliances. It then discusses the various stoma accessories and gives recommendations for when and how they should be used.
KEY WORDS
w Stoma w Colostomy w Ileostomy w Urostomy w Accessory w Appliance
396
commonly formed from the colon and termed a colonic conduit. In appearance, the urostomy also has a small spout and is red and round. A urostomy will pass urine with small amounts of mucus produced from the conduit into a drainable appliance fastened with a tap or bung. The appliance is emptied 4–6 times daily and is also replaced on a daily or alternate-daily basis.
Stoma appliances As already mentioned, there are three main types of appliances: colostomy (closed), ileostomy (drainable) and urostomy (drainable with a tap or bung). A stoma appliance is made of two parts: the adhesive part (which is also termed a flange, base plate or face plate), and the collection part, which can be separate to the flange (a two-piece appliance) or joined to the flange (a onepiece appliance) (Williams, 2006a). The flange is usually flat, which is suitable for the majority of people with a stoma. For ostomates with a flush or retracted stoma and a leaking appliance, it might be necessary to use a convex appliance (Redmond et al, 2009). A convex appliance has a dome-shaped flange, pushing the flange into the skin around the stoma. A convex appliance can be held tighter to the abdominal wall by using a small elastic belt clipped to the edge of the stoma appliance. It should be noted that a rare but serious complication associated with the use of a convex appliance involving damage to the peristomal skin (skin around the stoma) can occur. The peristomal skin can become bruised or, at worst, eroded; thus, it is essential to review the effect of the convex appliance to ensure that it is effectively resolving the appliance leakage without resulting in skin trauma.
Mouldable flanges There are also flanges available that instead of being cut to shape can be moulded into shape. These are available as flat and convex flanges (e.g. Natura ConvaTec Mouldable Technology Skin Barrier).
Accessories There is a range of stoma accessories (Box 1) to be used in conjunction with a stoma appliance (Rudoni and Dennis, 2009). Prior to the use of a stoma accessory it is essential to undertake a full assessment (Burch, 2014). Assessing the stoma and peristomal skin involves observing the skin and describing its condition, including the extent of skin dam-
© 2014 MA Healthcare Ltd
A
stoma is an artificial opening on the front of the abdomen, created surgically to divert either faeces or urine (Bupa, 2012). A stoma is formed for a variety of reasons, including bowel cancer, bladder cancer, diverticular disease and inflammatory bowel disease. A stoma is formed during a surgical procedure where the output from the bowel and/or bladder are re-routed. The stoma is the bowel that is brought through the abdominal wall, where it is stitched in place using disposable sutures. There are three main types of stoma: a colostomy, ileostomy and urostomy (Burch, 2008)—each requiring a slightly different stoma appliance.
Email: [email protected]
British Journal of Community Nursing August 2014 Vol 19, No 8
sh Journal of Community Nursing.Downloaded from magonlinelibrary.com by 130.088.090.140 on January 14, 2015. For personal use only. No other uses without permission. . All rights rese
CLINICAL UPDATE
Accessory
Example
Adhesive paste
Dansac Soft Paste; Hollister Adapt Paste; Pelican Paste
Adhesive remover spray
M&A Pharmachem Peel Easy Medical Adhesive Remover Spray; Salts WipeAway PLUS Adhesive Remover Spray
Adhesive remover wipe
CliniMed Appeel No Sting Medical Adhesive Remover Wipe
Belt
B. Braun Almarys belt
Protective cream
3M Cavilon Durable Barrier Cream
Protective stoma powder
OakMed Stoma Powder
Protective spray
ConvaTec Sensi-Care Protective Barrier Spray
Protective wipe
OstMART OstoGUARD No Sting Barrier Film
Retention strip
Welland HydroFrame
Seal/washer
Bullen Shelter Safe Seals
Strip paste
Coloplast Brava Strip Paste
Table 1. Stoma appliance and accessory manufacturers Manufacturer
Website
3M Healthcare
solutions.3m.co.uk/wps/portal/3M/ en_GB/HealthCare/Home/
B. Braun Medical
www.bbraun.co.uk
Bullen Healthcare
www.bullens.com
Clinimed
www.clinimed.co.uk
Coloplast
www.coloplast.co.uk
Convatec
www.convatec.co.uk
Dansac
www.dansac.co.uk
Hollister
www.hollister.com
M&A Pharmachem
www.mapharmachem.co.uk
Oakmed
www.oakmed.co.uk
Opus Healthcare
www.opus-healthcare.co.uk
Ostomart
www.ostomart.co.uk
Pelican Healthcare
www.pelicanhealthcare.co.uk
Respond Plus
www.respondplus.co.uk
Salts Healthcare
www.salts.co.uk
Welland Medical
www.wellandmedical.com
398
age (if any). It is also important to review what has changed prior to the issue occurring, what (if any) treatment has been tried already, and the effect. Once a treatment plan has been determined it should be implemented and subsequently reviewed to ensure efficacy. Appropriate assessment, planning, implementation and review ensures that the appropriate products are used, as stoma accessories are expensive (Black, 2009). However, if used appropriately it is actually possible to make savings to prescription costs (Boyles, 2010). It is also important to regularly review products, as any product that is no longer used should be deleted from the prescription.
Products Stoma accessories and appliances are manufacturered by a range of companies (Table 1), and many organisations have informative websites that both patients and nurses can access and obtain useful items that can improve quality of life. For example, a commonly reported problem is leakage from the stoma appliance. Some stoma accessories are available from health-care manufacturers that can be used to help the stoma appliance adhere to the abdominal wall. Other products protect the skin from damage that may be incurred through contact with the stomal output (contact dermatitis) or from frequent removal of the stoma appliance (skin stripping). Furthermore, there are products available to help treat sore peristomal skin. The following sections discuss the various types of products available in more detail.
Products to secure the appliance When assessing a patient with a leaking appliance, it is essential to understand the reason that the appliance is leaking. If the skin is not level, then this needs to be addressed. If the skin is damaged and oozing, this needs to be treated (this will be discussed later), or if the stoma is below the level of the skin this needs to be resolved. Treatment for the latter often involves the use of a convex appliance, as discussed previously. The skin around the stoma under the flange may have a crease or dip, which might be the result of weight loss or gain. If this is noted upon examination of the abdominal wall, then treatment might be the use of a seal or washer (Black, 2013). This is a round product that has a hole in the centre made from hydrocolloid (the same product used in most stoma flanges, but more pliable). The seal may be used around the stoma in its entirety or it can be broken and used in the skin dip. Strip paste is a more pliable alternative, and adhesive paste is more pliable still. Decisions over which is the most appropriate product to use will depend upon the skin evaluation. In some situations adhesive paste can be used with a small section of seal or strip paste. It should be noted that most pastes are made more pliable through the use of alcohol. Alcohol will sting broken skin, so it should be used with caution if the skin is not intact. In addition, as it is very pliable it
© 2014 MA Healthcare Ltd
Box 1. Stoma accessories
British Journal of Community Nursing August 2014 Vol 19, No 8
sh Journal of Community Nursing.Downloaded from magonlinelibrary.com by 130.088.090.140 on January 14, 2015. For personal use only. No other uses without permission. . All rights rese
CLINICAL UPDATE
Flange retention strips Other products that can improve stoma security are flange retention strips. These are strips of hydrocolloid used around the edges of the stoma flange to aid adhesion. Flange retention strips should not be used until there has been a full assessment to establish why they are necessary. This product should not be used to stop a leak as the stomal output will simply be collected under the stoma flange.
Products to protect peristomal skin There are also products available to help protect peristomal skin. If skin is regularly red but not broken and/or if the skin is at risk of damage from the stomal output, a protective barrier may be useful.This product is available as a spray, wipe or cream. A variety of names are used to describe this product, including skin barrier, protective spray and protective skin barrier (Ferrer et al, 2010). The spray or wipe is useful to protect intact skin by leaving a thin barrier (Black, 2009). If skin is excessively dry, then a barrier cream under the stoma appliance flange may be useful. If the cream is used minimally, it will provide moisture while preventing the skin from becoming greasy, as the stoma appliance will then fail to adhere to the abdominal wall. If skin is damaged by frequent change of the stoma appliance, an adhesive remover can be used to help remove the adhesive and prevent skin stripping (Berry et al, 2007). If the appliance is being removed too frequently, a two-piece appliance may be useful.
KEY POINTS
w There are three main types of stoma: a colostomy, ileostomy and urostomy w The above three types of stoma appliance are closed, drainable, and drainable fastened with a tap or bung, respectively
w Stoma accessories can be used to resolve issues such as leakage and sore skin
w Stoma accessories include paste, powder, seal and protective film w Stoma specialist nurses are available in most hospitals and should be contacted by patients or community nurses for further advice
400
Products to treat sore peristomal skin A variety of products are available to help the skin heal. The most simple is the stoma appliance flange. The aperture (hole) in the appliance should be checked to ensure that it is the correct size: it should be 2–3 mm larger and the same shape as the stoma. If it is the incorrect size and the skin is red, or broken but not oozing, then changing the aperture size and using the hydrocolloid within the flange might be all that is required to assist in returning the skin to a healthy state. If the skin is wet and oozing, a stoma accessory such as a protective powder might be useful. Powder is made from hydrocolloid, so it has healing properties. It is designed to be minimally used on wet or moist peristomal skin, under the stoma flange. If too much powder is applied to the wet skin, it should be gently removed, as too much powder will clump and may well reduce the adhesive properties of the appliance (Williams, 2006b).
Conclusion It can be seen that there is a wide variety of stoma appliance types and accessories. These can be used to resolve issues with the stoma that may arise in the community setting. It is essential that a full assessment is made prior to the instigation of any treatment. Stoma specialist nurses are available at most local hospitals and can be contacted if matters do not resolve easily. BJCN
Black P (2009) Stoma care nursing management cost implication in community care. Br J Community Nurs 14(8): 350–5 Black P (2011) Coping with common stoma problems in care homes. Nurs Residential Care 13(3): 126–8 Black P (2013) The role of accessory products in patients with a stoma. Br J Nurs 22(5): S24 Berry J, Black P, Smith R, Stuchfield B (2007) Assessing the value of silicone and hydrocolloid products in stoma care. Br J Nurs 16(13): 778–88 Boyles A (2010) Keeping up to date with stoma care accessories: enabling informed choice. Gastroint Nurs 8(6): 28–42 Bupa (2012) Stoma care: information. http://tinyurl.com/py9geub (accessed 22 July 2014) Burch J (2008) Stomas—the past, present and future. In: Burch J, ed, Stoma Care. Wiley-Blackwell, West Sussex Burch J (2014) Care of patients with peristomal skin complications. Nurs Stand 28(37): 51–7 Ferrer K, Kenyon V, Smith AJ (2010) Stoma appliances, specialist nurse, and the multidisciplinary team. In: Lyon CC, Smith AJ, eds, Abdominal Stomas and their Skin Disorders: An Atlas of Diagnosis and Management, 2nd edn. Informa Healthcare, London Redmond C, Cowin C, Parker T (2009) The experience of faecal leakage among ileostomists. Br J Nurs 18(17): S12–17 Rudoni C, Dennis H (2009) Accessories or necessities? Exploring consensus on usage of stoma accessories. Br J Nurs 18(18): 1106–12 Williams J (2006a) Stoma care part 1: choosing the right appliance. Gastroint Nurs 4(6): 16–19 Williams J (2006b) Stoma care part 2: choosing appliance accessories. Gastroint Nurs 4(7): 16–19
© 2014 MA Healthcare Ltd
takes some time to dry and thus should be minimally used. The abdomen should not be moved excessively for some time (30–60 minutes is adequate in most situations) to allow the paste to dry and the appliance to become secure after the paste is used.
British Journal of Community Nursing August 2014 Vol 19, No 8
sh Journal of Community Nursing.Downloaded from magonlinelibrary.com by 130.088.090.140 on January 14, 2015. For personal use only. No other uses without permission. . All rights rese
Stoma care in the community Jennie Burch
Enhanced Recovery Nurse Facilitator, St Mark's Hospital, Harrow, Middlesex
Stomas Stomas can be permanent or temporary. Temporary stomas are closed or reversed in a subsequent operation, months or years after the stoma is formed. The colostomy is formed from the large bowel or colon. In appearance, the colostomy is red, round or egg-shaped and ideally minimally raised above the abdominal wall. A colostomy will pass flatus and formed faeces into a closed stoma appliance or bag (Black, 2011). Colostomy appliances are replaced every few days to several times daily—commonly once per day. An ileostomy is formed from the small bowel or ileum. In appearance, the ileostomy is red, round or egg-shaped and is ideally formed with a small 25 mm spout. An ileostomy will pass flatus and loose faeces into a drainable appliance fastened with a Velcro-type fastening. The appliance requires emptying 4–6 times daily and is usually changed on a daily or alternate-daily basis. Finally, urostomies are usually formed from the ileum, giving the name ileal conduit. It is less
Abstract
There are over 100 000 people in the UK with a stoma. For nurses working within the community and dealing with a variety of conditions, making a decision regarding the most appropriate stoma appliance to use on ostomates can be a challenge. This article gives a general overview of stomas and stoma appliances. It then discusses the various stoma accessories and gives recommendations for when and how they should be used.
KEY WORDS
w Stoma w Colostomy w Ileostomy w Urostomy w Accessory w Appliance
396
commonly formed from the colon and termed a colonic conduit. In appearance, the urostomy also has a small spout and is red and round. A urostomy will pass urine with small amounts of mucus produced from the conduit into a drainable appliance fastened with a tap or bung. The appliance is emptied 4–6 times daily and is also replaced on a daily or alternate-daily basis.
Stoma appliances As already mentioned, there are three main types of appliances: colostomy (closed), ileostomy (drainable) and urostomy (drainable with a tap or bung). A stoma appliance is made of two parts: the adhesive part (which is also termed a flange, base plate or face plate), and the collection part, which can be separate to the flange (a two-piece appliance) or joined to the flange (a onepiece appliance) (Williams, 2006a). The flange is usually flat, which is suitable for the majority of people with a stoma. For ostomates with a flush or retracted stoma and a leaking appliance, it might be necessary to use a convex appliance (Redmond et al, 2009). A convex appliance has a dome-shaped flange, pushing the flange into the skin around the stoma. A convex appliance can be held tighter to the abdominal wall by using a small elastic belt clipped to the edge of the stoma appliance. It should be noted that a rare but serious complication associated with the use of a convex appliance involving damage to the peristomal skin (skin around the stoma) can occur. The peristomal skin can become bruised or, at worst, eroded; thus, it is essential to review the effect of the convex appliance to ensure that it is effectively resolving the appliance leakage without resulting in skin trauma.
Mouldable flanges There are also flanges available that instead of being cut to shape can be moulded into shape. These are available as flat and convex flanges (e.g. Natura ConvaTec Mouldable Technology Skin Barrier).
Accessories There is a range of stoma accessories (Box 1) to be used in conjunction with a stoma appliance (Rudoni and Dennis, 2009). Prior to the use of a stoma accessory it is essential to undertake a full assessment (Burch, 2014). Assessing the stoma and peristomal skin involves observing the skin and describing its condition, including the extent of skin dam-
© 2014 MA Healthcare Ltd
A
stoma is an artificial opening on the front of the abdomen, created surgically to divert either faeces or urine (Bupa, 2012). A stoma is formed for a variety of reasons, including bowel cancer, bladder cancer, diverticular disease and inflammatory bowel disease. A stoma is formed during a surgical procedure where the output from the bowel and/or bladder are re-routed. The stoma is the bowel that is brought through the abdominal wall, where it is stitched in place using disposable sutures. There are three main types of stoma: a colostomy, ileostomy and urostomy (Burch, 2008)—each requiring a slightly different stoma appliance.
Email: [email protected]
British Journal of Community Nursing August 2014 Vol 19, No 8
sh Journal of Community Nursing.Downloaded from magonlinelibrary.com by 130.088.090.140 on January 14, 2015. For personal use only. No other uses without permission. . All rights rese
CLINICAL UPDATE
Accessory
Example
Adhesive paste
Dansac Soft Paste; Hollister Adapt Paste; Pelican Paste
Adhesive remover spray
M&A Pharmachem Peel Easy Medical Adhesive Remover Spray; Salts WipeAway PLUS Adhesive Remover Spray
Adhesive remover wipe
CliniMed Appeel No Sting Medical Adhesive Remover Wipe
Belt
B. Braun Almarys belt
Protective cream
3M Cavilon Durable Barrier Cream
Protective stoma powder
OakMed Stoma Powder
Protective spray
ConvaTec Sensi-Care Protective Barrier Spray
Protective wipe
OstMART OstoGUARD No Sting Barrier Film
Retention strip
Welland HydroFrame
Seal/washer
Bullen Shelter Safe Seals
Strip paste
Coloplast Brava Strip Paste
Table 1. Stoma appliance and accessory manufacturers Manufacturer
Website
3M Healthcare
solutions.3m.co.uk/wps/portal/3M/ en_GB/HealthCare/Home/
B. Braun Medical
www.bbraun.co.uk
Bullen Healthcare
www.bullens.com
Clinimed
www.clinimed.co.uk
Coloplast
www.coloplast.co.uk
Convatec
www.convatec.co.uk
Dansac
www.dansac.co.uk
Hollister
www.hollister.com
M&A Pharmachem
www.mapharmachem.co.uk
Oakmed
www.oakmed.co.uk
Opus Healthcare
www.opus-healthcare.co.uk
Ostomart
www.ostomart.co.uk
Pelican Healthcare
www.pelicanhealthcare.co.uk
Respond Plus
www.respondplus.co.uk
Salts Healthcare
www.salts.co.uk
Welland Medical
www.wellandmedical.com
398
age (if any). It is also important to review what has changed prior to the issue occurring, what (if any) treatment has been tried already, and the effect. Once a treatment plan has been determined it should be implemented and subsequently reviewed to ensure efficacy. Appropriate assessment, planning, implementation and review ensures that the appropriate products are used, as stoma accessories are expensive (Black, 2009). However, if used appropriately it is actually possible to make savings to prescription costs (Boyles, 2010). It is also important to regularly review products, as any product that is no longer used should be deleted from the prescription.
Products Stoma accessories and appliances are manufacturered by a range of companies (Table 1), and many organisations have informative websites that both patients and nurses can access and obtain useful items that can improve quality of life. For example, a commonly reported problem is leakage from the stoma appliance. Some stoma accessories are available from health-care manufacturers that can be used to help the stoma appliance adhere to the abdominal wall. Other products protect the skin from damage that may be incurred through contact with the stomal output (contact dermatitis) or from frequent removal of the stoma appliance (skin stripping). Furthermore, there are products available to help treat sore peristomal skin. The following sections discuss the various types of products available in more detail.
Products to secure the appliance When assessing a patient with a leaking appliance, it is essential to understand the reason that the appliance is leaking. If the skin is not level, then this needs to be addressed. If the skin is damaged and oozing, this needs to be treated (this will be discussed later), or if the stoma is below the level of the skin this needs to be resolved. Treatment for the latter often involves the use of a convex appliance, as discussed previously. The skin around the stoma under the flange may have a crease or dip, which might be the result of weight loss or gain. If this is noted upon examination of the abdominal wall, then treatment might be the use of a seal or washer (Black, 2013). This is a round product that has a hole in the centre made from hydrocolloid (the same product used in most stoma flanges, but more pliable). The seal may be used around the stoma in its entirety or it can be broken and used in the skin dip. Strip paste is a more pliable alternative, and adhesive paste is more pliable still. Decisions over which is the most appropriate product to use will depend upon the skin evaluation. In some situations adhesive paste can be used with a small section of seal or strip paste. It should be noted that most pastes are made more pliable through the use of alcohol. Alcohol will sting broken skin, so it should be used with caution if the skin is not intact. In addition, as it is very pliable it
© 2014 MA Healthcare Ltd
Box 1. Stoma accessories
British Journal of Community Nursing August 2014 Vol 19, No 8
sh Journal of Community Nursing.Downloaded from magonlinelibrary.com by 130.088.090.140 on January 14, 2015. For personal use only. No other uses without permission. . All rights rese
CLINICAL UPDATE
Flange retention strips Other products that can improve stoma security are flange retention strips. These are strips of hydrocolloid used around the edges of the stoma flange to aid adhesion. Flange retention strips should not be used until there has been a full assessment to establish why they are necessary. This product should not be used to stop a leak as the stomal output will simply be collected under the stoma flange.
Products to protect peristomal skin There are also products available to help protect peristomal skin. If skin is regularly red but not broken and/or if the skin is at risk of damage from the stomal output, a protective barrier may be useful.This product is available as a spray, wipe or cream. A variety of names are used to describe this product, including skin barrier, protective spray and protective skin barrier (Ferrer et al, 2010). The spray or wipe is useful to protect intact skin by leaving a thin barrier (Black, 2009). If skin is excessively dry, then a barrier cream under the stoma appliance flange may be useful. If the cream is used minimally, it will provide moisture while preventing the skin from becoming greasy, as the stoma appliance will then fail to adhere to the abdominal wall. If skin is damaged by frequent change of the stoma appliance, an adhesive remover can be used to help remove the adhesive and prevent skin stripping (Berry et al, 2007). If the appliance is being removed too frequently, a two-piece appliance may be useful.
KEY POINTS
w There are three main types of stoma: a colostomy, ileostomy and urostomy w The above three types of stoma appliance are closed, drainable, and drainable fastened with a tap or bung, respectively
w Stoma accessories can be used to resolve issues such as leakage and sore skin
w Stoma accessories include paste, powder, seal and protective film w Stoma specialist nurses are available in most hospitals and should be contacted by patients or community nurses for further advice
400
Products to treat sore peristomal skin A variety of products are available to help the skin heal. The most simple is the stoma appliance flange. The aperture (hole) in the appliance should be checked to ensure that it is the correct size: it should be 2–3 mm larger and the same shape as the stoma. If it is the incorrect size and the skin is red, or broken but not oozing, then changing the aperture size and using the hydrocolloid within the flange might be all that is required to assist in returning the skin to a healthy state. If the skin is wet and oozing, a stoma accessory such as a protective powder might be useful. Powder is made from hydrocolloid, so it has healing properties. It is designed to be minimally used on wet or moist peristomal skin, under the stoma flange. If too much powder is applied to the wet skin, it should be gently removed, as too much powder will clump and may well reduce the adhesive properties of the appliance (Williams, 2006b).
Conclusion It can be seen that there is a wide variety of stoma appliance types and accessories. These can be used to resolve issues with the stoma that may arise in the community setting. It is essential that a full assessment is made prior to the instigation of any treatment. Stoma specialist nurses are available at most local hospitals and can be contacted if matters do not resolve easily. BJCN
Black P (2009) Stoma care nursing management cost implication in community care. Br J Community Nurs 14(8): 350–5 Black P (2011) Coping with common stoma problems in care homes. Nurs Residential Care 13(3): 126–8 Black P (2013) The role of accessory products in patients with a stoma. Br J Nurs 22(5): S24 Berry J, Black P, Smith R, Stuchfield B (2007) Assessing the value of silicone and hydrocolloid products in stoma care. Br J Nurs 16(13): 778–88 Boyles A (2010) Keeping up to date with stoma care accessories: enabling informed choice. Gastroint Nurs 8(6): 28–42 Bupa (2012) Stoma care: information. http://tinyurl.com/py9geub (accessed 22 July 2014) Burch J (2008) Stomas—the past, present and future. In: Burch J, ed, Stoma Care. Wiley-Blackwell, West Sussex Burch J (2014) Care of patients with peristomal skin complications. Nurs Stand 28(37): 51–7 Ferrer K, Kenyon V, Smith AJ (2010) Stoma appliances, specialist nurse, and the multidisciplinary team. In: Lyon CC, Smith AJ, eds, Abdominal Stomas and their Skin Disorders: An Atlas of Diagnosis and Management, 2nd edn. Informa Healthcare, London Redmond C, Cowin C, Parker T (2009) The experience of faecal leakage among ileostomists. Br J Nurs 18(17): S12–17 Rudoni C, Dennis H (2009) Accessories or necessities? Exploring consensus on usage of stoma accessories. Br J Nurs 18(18): 1106–12 Williams J (2006a) Stoma care part 1: choosing the right appliance. Gastroint Nurs 4(6): 16–19 Williams J (2006b) Stoma care part 2: choosing appliance accessories. Gastroint Nurs 4(7): 16–19
© 2014 MA Healthcare Ltd
takes some time to dry and thus should be minimally used. The abdomen should not be moved excessively for some time (30–60 minutes is adequate in most situations) to allow the paste to dry and the appliance to become secure after the paste is used.
British Journal of Community Nursing August 2014 Vol 19, No 8
sh Journal of Community Nursing.Downloaded from magonlinelibrary.com by 130.088.090.140 on January 14, 2015. For personal use only. No other uses without permission. . All rights rese
