Most patients are concerned about the state of their peri-stomal skin. Poor care in this area leaves stool and urine residues. This leads to contamination which in turn causes skin irritation, increased risk of infection and other stoma complications. Ostomy skin barriers (also referred to as wafers or flanges) are used to minimize such incidences.
How ostomy skin barriers prevent skin irritation?
They form a tight seal around the stoma so that once the pouch is attached no discharge comes into contact with the skin. A skin barrier can be part of the pouch as in a one piece ostomy bag or be separate as in a two-piece system.
Properties of a good ostomy skin barrier:
-It securely protects the skin around the stoma from contamination with urine or stool.
-Adhesiveness is not affected by wetness or body moisture, an important feature for patients who perspire a lot.
-Protects against discharge odors.
-Causes no friction to the skin around the stoma.
-Continues to be effective even when the stoma shape changes. The size of the stoma usually gets smaller once post-surgery swelling diminishes (patients must size down accordingly).
-It peels off painlessly causing no injury to the skin during removal.
Types of ostomy skin barriers:
The type of barrier used is determined by the patient’s preference and the contours of the stoma. Common types include:
-Cut-to-fit skin barriers, used for irregularly shaped stomas or for those reducing in size.
-Pre-cut skin barriers, ideal for well-marked and round stomas.
-Convex skin barriers protrude towards the skin around the stoma so as to fit flat or retracted stomas
-Moldable wafers are molded (manipulated) to the patient’s body contours.
-Flexible skin barriers adapt to skin folds and curves.
In situations where the skin is irritated or inflamed, a standard wear skin barrier may be used. Standard barriers absorb most of the moisture from the peristomal skin and maintain low adhesiveness so that, little or no skin trauma occurs during removal. Extended wear skin barriers are used when the barrier is to remain for longer periods. If the stoma drains urine or liquidy stool, extended wear barriers are better absorbing moisture while retaining adhesive strength.
Prepping for ostomy skin barrier placement
The skin around the stoma is commonly prepared with wipes, sprays or creams. The aim is to place the skin barrier on a clean surface so as to reduce risks of skin injury during wafer removal. Some patients have sensitive skins and can react to skin preparation substances or even the ostomy skin barrier material. Any history of skin sensitivity should be reported to the ostomy nurse for evaluation including allergy or other pertinent tests.