Lesson 28: Difficult Stomas

Question 1

Factors Impacting Secure Seal

Answer 1

• Peristomal skin contours
• position of stomal os relative to peristomal skin
• volume + consistency of output
• patient specific factors
• emergency procedures
• obesity
• shortened stay in a true care
• lack of long-term access to supports

Question 2

Common pouching concerns

Answer 2

• stoma in/adjacent to deep crease
• Stoma in shallow crease
• Irregular peristomal skin contours
• Stomal os at or below skin surface
• Partial or total stomal retraction
• Stoma and wound combination

Question 3

Flat or Rounding Surface with Central Os

Answer 3

Options
- One-piece flat
- Two-piece flat
- Paste or barrier ring PRN for high output liquid stool

Question 4

Stoma in/adjacent to deep crease

Answer 4

Always all flexible, one-piece
- Size opening depending on os

Above skin level = sized to fit closely around stoma

At or below skin level = size with ⅛ - ¼ clearance

Fecal stoma
- Protect exposed skin with filler products

Question 5

Stoma in Shallow Crease

Answer 5

• Convex pouch with added belt
• Flexible pouch is possible
• Only if abdo is firm an os is above skin level
• Filler to crease flat pouching surface

Question 6

Stoma in Concave Valley

Answer 6

• Convex pouching system
• Need to match level of convexity with depth of valley
• Belt PRN

Question 7

Stoma with Skin-Level Os

Answer 7

Convex pouch cut to fit close to stoma
- Surface variable (concave, flat, or shallow crease)

Belt PRN

If deep crease
- All flexible pouch with ⅛ - ¼ clearance

Question 8

Uneven Pouching Surface

Answer 8

• Use of filler products to create flat pouching surface

Os at skin level
- Need to flatten filler products to stool doesn’t pool
- Convex pouch

Os protruding
- Flat pouch

Question 9

Stoma + Wound Combination

Answer 9

Begins with wound bed
- dress appropriately
- cover with barrier ring or Hydrocolloid sheet

Pouch according to stoma and os contours

Question 10

Pouching Convexity: Shallow vs Deep

Answer 10

Shallow = skin level os on flat surface

Deep = stoma in deep concave valley

Question 11

Pouching Convexity: Soft vs Firm

Answer 11

Soft = firm abdomen
- Good for early post-op
- Less tension on suture line

Firm = soft abdomen

Question 12

Pouching Convexity: Round vs Oval

Answer 12

Dependant on stomal shape

Question 13

Pouching Convexity: Integrated vs Add-on

Answer 13

Integrated = skin level os
- Provides flat, convex “ramp” to promote drainage

Add-on = protruding stoma and os
- Addition of thick, convex ring
- Intended for use in concave valley