Exploring the Intricacies of Stoma Care

1. Exploring the Intricacies of Stoma Care Date: 25 June 2018Presented by: Bernadette Ambrose Stoma Care Nurse Specialist West Suffolk Community

2. Introduction • Some common reasons for stoma formation • Overview of the 3 types of stomas • The importance of Skin Health • ‘p’ Ratings in West Suffolk • Accessory usage

3. Some common reasons for Stoma formation • Carcinoma (bowel & bladder) • Diverticulitis • Inflammatory Bowel Disease • Familial Polyposis • Trauma • Neurological damage (M.S.) • Incontinence • Congenital Disorders

4. Colostomy A colostomy is formed from the large bowel Can be permanent or temporary Can be a loop or an end stoma Output is usually formed or soft faeces Generally use a closed bag Pouch change depends on bowel function can be 2-3 times a day

6. Loop Colostomy

7. Ileostomy • Formed from the ileum • Generally on the R side • May be temporary or permanent • Loop or end, should be spouted (2.5cm) • Output – loose, porridge like consistency • Use a drainable bag • Empty 4-6 x day and change alternate days

9. Urostomy • Formed form a section of bowel used to form a conduit into which ureters are attached. • Always permanent, end stoma • Urine will always contains some mucus • Pouch with a tap or a bung • Emptied 5-6 times a day • Bag changed alternate days

11. The ‘Perfect’ Stoma • Until the advent of the Brookes ileostomy, there was no gold standard forthe formation of a spouted ileostomy & ileal conduit.1 • St Marks’ Hospital London UK published a paper written by Celia Myers and Robin Phillips to set the new standard for a slightly spouted colostomy.2 • History of Ostomy Surgery – D. Doughty. Journal of Wound, Ostomy, & Continence Nursing Vol. 35, No. 1. 2008 • 2. Minimally Raised End Colostomy – B.M. Stephenson., C. Myers, R.K.S. Phillips. International Journal of Colorectal Disease Vol. 10. No. 4. 1995.

12. Perfect Ileostomy/Urostomy

13. However……

14. The Skin Largest organ Divided into 2 Layers Epidermis Dermis Functions Thermoregulation Protection Waterproofing Synthesis of Vit D sensation Differs in appearance & Structure Location Age Disease

15. Consequences of a NOT so perfect stoma

17. Many people with a stoma may experience complications at some point. Many factors contribute to a problematic stoma In 2008 we initiated the ‘P’ Rating system where each stoma formed at the WSH was given a rating depending on the number of accessories required to ensure a secure fit. The purpose of this was to initiate discussion and help improve the quality of the stomas formed, thereby improving the patients quality of life and reducing the cost in accessory usage. The Problematic Stoma

18. ‘P’ RATINGS - A STOMA GRADING TOOL

19. ‘p’ Ratings Overview of p0 – p1 Stomas In 2017 72% of all stomas formed at the WSH did not require any accessories to achieve the perfect Fit.

20. The Importance of a Good Fit

21. Conclusion • My role as a Stoma Care nurse explores the intricacies of Stoma Care on a daily basis. • Skin Health is paramount to ensure the patient continues to have the confidence and ability to lead an active and full life following this life changing surgery.