Matching Ostomy Pouching Systems to Patient Need
The American Cancer Society estimates that in 2013, 142,820 individuals in the United States will be diagnosed with colorectal cancer and 72,570 with bladder cancer
Yvonne Weideman, DNP, MBA, RN, CNE
Assistant Professor, Duquesne University, Pittsburgh, PA
The American Cancer Society estimates that in 2013, 142,820 individuals in the United States will be diagnosed with colorectal cancer and 72,570 with bladder cancer.1,2 Many patients affected by these cancers will require either a temporary or permanent ostomy. During the past decade, changes in ostomy product options offer patients a variety of choices. Knowledgeable nurses who can match a patient’s ostomy needs to the appropriate product ensure that patients experience the highest degree of comfort, ease, and security.
These product decisions fall into four general categories: pouching systems, skin barriers (also called wafers or flanges), pouches, and accessories.
Pouching methods can be either one- or twopiece systems based on whether or not the wafer and pouch are combined into a single unit or function separately. One-piece systems tend to be thinner and more flexible than two-piece systems. 3 This helps the barrier to mold to the body’s contours, making it a good choice for patients with an uneven peristomal skin surface, rods in place, decreased manual dexterity, and/or those who need to streamline the pouching system change procedure. For other patients, a two-piece system is a better option because the pouch can be removed without removing the barrier. Many patients prefer this system, as they are able to change the pouch while only needing to change the full system once or twice a week.4
Options for skin barriers include cut to fit, precut, and convex. Cut-to-fit barriers, where the opening is cut manually, provide a custom fit for each stoma. These barriers are often used in the postoperative period due to the stoma decreasing in size as edema resolves. Once the stoma size and shape stabilizes, a precut barrier where the opening is cut during the manufacturing process may be an option.5 Designed to fit standard round and/or oval stomas, these barriers eliminate several steps in the change procedure; however, they are not designed for stomas that are irregular in shape or size.4
United Ostomy Associations of America, Inc.— www.uoaa.org
Wound Ostomy and Continence Nurses Society— www.wocn.org
American Cancer Society—www.cancer.org
American College of Surgeons Surgical Patient Education Program — http://surgicalpatienteducation.org
Standard skin barriers have a flat surface on the back, whereas convex barriers have a rounded or curved backing. Convex barriers are used for patients whose stoma is flush to the abdominal surface, retracted below the skin surface, located in a skinfold, or when the stoma opening rests against the abdominal skin.5 The convex shape of the barrier pushes the peristomal skin down, helping the stoma output to be directed into the pouch, versus between the barrier and the peristomal skin causing leakage.
Pouch options involve transparency, filter, size and ability to be drained. Transparent pouches facilitate visualization and assessment of the stoma during the immediate postoperative period; opaque pouches conceal the ostomy’s output. Filtered pouches allow for elimination of gas from the pouch, thus preventing the pouch from ballooning in size and becoming visible under clothing. Nonfiltered pouches enable the patient to control the time and place for gas to be released from the pouch. The bottom of the pouch may be opened, closed, or contain a spout to facilitate drainage. Closed-end pouches must be completely removed to empty the pouch. This type of pouch works well for patients with descending colostomies due to output that is thick or formed and difficult to drain from a pouch.3
Open-ended pouches have a clip or Velcro at the bottom of the pouch that allows the pouch to be opened and emptied periodically throughout the day. This is effective for output that is thin or liquid in consistency, such as that of ileostomies and ascending colostomies. Spigot-type openings have an on-and-off position to control emptying of the pouch. These are typically utilized for urostomy patients.
Accessory options include belts, adhesives, barrier sprays and powder, and designer-wear items. Ostomy belts are often worn for additional security and comfort, especially during physical exerexertion. Adhesives come in the form of strips, paste, flat rings, and convex ovals. They are utilized to fill in crevices in the peristomal skin to create a flat surface and facilitate barrier adherence and increased wearing time. Barrier sprays are used for additional protection of the peristomal skin against irritation and leakage. Stoma powders are used to absorb moisture and to provide protection when the patient experiences denuding of the peristomal skin.
Designer-wear items include specialty products that facilitate an active lifestyle. Products such as neoprene pouches/belts that encompass the patient’s pouching system offer support and waterproof protection for swimming, snowboarding, etc. Additionally, there are sport shorts for men and women with an interlining that contains the pouching system to provide additional support and protection.
The selection of appropriate products to meet patients’ individualized ostomy needs can facilitate prevention of common stomal and peristomal skin complications, as well as ensure the highest degree of comfort, ease, and security.
- The American Cancer Society. Leading New Cancer Cases and Deaths—2013. www.cancer.org/acs/groups/content/@epidemiologysurveilance/ documents/document/acspc-037129.pdf. Accessed July 14, 2013.
- The American Cancer Society. Bladder Cancer. www.cancer.org/cancer/ bladdercancer/detailedguide/index. Accessed July 14, 2013.
- Bak GP. Teaching ostomy patients to regain their independence. American Nurse Today. 2008;3(3):30-35.
- Weideman YL, Dunn DJ, Culleiton AL. Ostomy Management. It’s easier than you think. Brockton, MA: Western Schools. 2012:27-29.
- Zane Cohen Centre for Digestive Diseases. Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex. Ostomy Care—Selecting an Appliance. http://www.zanecohencentre.com/ibd/for-patients/ostomy-care. Accessed July 14, 2013.