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Stoma Care
It is crucial to assess the patient's skin before applying the stoma pouch and when removing it. As a rule of thumb, peristomal skin should appear the same as the abdominal skin (Stelton, 2019); it should not look discoloured in any way and the patient’s normal skin tone should always be compared during this assessment to ensure no indicators of skin damage are missed. It is also important to assess the patient holistically, including noting the impact of stoma on their lifestyle, any comorbidities/risk factors, and the placement and type of stoma. Table 2 lists tips for practice when assessing a patient for PMASD and PMARSI. Table 2. Assessment tips for PMASD and PMARSI detection (adapted from Wounds UK, 2021) Skin damage Possible presentation Tips for practice PMASD
A
B
skin intact: this can happen if peristomal skin is not strong (e.g. PMASD) or if pouch removal technique is not appropriate (Le Blanc, 2019). Studies show that this complication is common but under-reported (Le Blanc et al, 2013; Stelton, 2019). Due to their impact, PMASD and PMARSI require multi-step prevention and management approaches that should be tailored and promptly implemented to ensure optimal outcome for the patient. Managing peristomal skin complications Progression of PMASD and PMARSI can be reduced by following the steps outlined in Figure 2 (Hadfield et al, 2019; Kelly-O’Flynn et al, 2020; Swift et al, 2021). Figure 1. The two major peristomal skin complications: a) Peristomal moisture-associated skin damage (PMASD); b) Peristomal medical-adhesive related skin injury (PMARSI)
Peristomal skin colour may change, look for: erythema, darkening, lightening or a blue/ purple hue
• Assess the skin thoroughly and regularly • Check the skin for changes in colour, temperature and texture (Cole and Waller, 2023) • Ensure that barrier products and medical adhesive removers are always used for patients, to maintain healthy skin • Ensure skin integrity is maintained by using a medical adhesive remover, when removing stoma pouches • Assess skin dryness and provide peristomal skin support when removing stoma pouches • Consider skin tone and tailor colour assessment to patients with dark or light skin
PMARSI
Erythema may be present; consider pain around stoma region an indicator
• Ensure the skin is clean and dry • Apply the barrier film (Medi Derma-S Total Barrier Film, Medicareplus International) and let it dry completely before attaching the medical adhesive device (i.e. the pouch). • Select the most appropriate medical adhesive device (i.e. the pouch) for the patient • Ensure it complies with the patient's skin and their movement. • Ensure smooth application of the medical adhesive device with no stretch/tension between the skin and the pouch • The pouch must be in full contact with the skin, with no pockets left. • Always use a medical adhesive remover (Lifteez Medical Adhesive Remover, Medicareplus International) while changing the pouch • Support the skin while slowly removing the pouch.
Prepare Skin
Choose Stoma Pouch
Always consider skin tone to ensure skin assessment is tailored to the individual patient and to avoid skin tone bias (Wounds UK, 2021); potential inequity in peristomal skin care exists and people with dark skin tones often experience more severe skin injuries before the damage is diagnosed (Gunowa et al, 2020).
Apply Stoma Pouch
The cost of peristomal skin complications to healthcare systems Pietzsch and Geislet et al (2019) estimate that, in the UK, colostomy care (the most common form of stoma in the UK population) costs approximately £8,167 per person over their lifetime (excluding the cost of adverse events). Overall, people with stomas also require more support from health services, which further increases their healthcare expense compared to the general population (Mthombeni et al, 2023).
Remove Stoma Pouch
Figure 2. Steps to manage peristomal skin complications
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