Wow! Hydrocolloid sheet + no-sting paste is da bomb!

[Shamrock4806]

Big big BIG improvement.

What I do is this.

I typically avoid changing a bag until flow has almost ceased by a prolong period of not eating or drinking. Usually overnight then in the morning after a nice shower with old bag removed. Hair.dryer (not hot) to dry up any skin moisture.

1: Fold and precut hole in sheet, can trim a bit to enlarge later.

2: Apply no-sting paste (brava) around stoma ever so slightly away from it and cutting the paste output in half using the nozzle as I apply it. It's difficult to work with and sticks to anything else easily so I smear it around in a circle around while pressing down and then pinching off while pressing down to remove it from my finger or nozzle. Difficult to explain anyway.

3: Next fold the sheet and test over stoma, trim to enlarge so it's a close fit around it, but not touching it.

4: Apply and press around to get the paste closer to the stoma but not oozing out, but if it does to pull the ooze back on top of the sheet. This method really allows a nice close fit around the stoma. If there gaps they can be filled in with the second layer of paste.

5: Apply the alcohol based, (it's more fluid) half level ring of paste close to stoma on top of sheet (fill any gaps near stoma) and apply appliance. Press down gently as not to get the hole blocked. Process also covers any gaps but alcohol based stings to let you know gap is covered.

Problem I was having was getting a good coverage of paste close to the stoma. Now with a visual using the sheet first I can press and remedy gaps with the second layer (stings as it's alcohol based) paste and that indicates I've covered the gap. Before it would sting like hell all around and wasn't covering as the final appliance hides things. Before I sort of justed winged it and hoped for the best which often needed to be replaced.

It's a more lengthy two step process however it's better at covering the skin around and protecting it from the acid based output which irritates the skin and makes ones life uncomfortable.

I'm also getting 3-4 days out of a bag now more frequently than just paste and appliance alone. Skin around is better condition as well.

Apply extra adhesive seal all around and a belt.

I use a one piece convex and use a bottle of water + mountain wash to rinse.

What an improvement..

[Shamrock4806]

Okay a big improvement, but not perfect.

Appears the paste (either alcohol or non-alcohol based) isn't fluid enough to flow into the tiny gap between the recessed stoma and the skin.

Skin barrier doesn't seem to work neither.

I need something like the consistency of painters caulk.

Any ideas?

[Mysticobra]

I use an adapt ring. No paste. I get seven and more days 98% of the time.
I don't use paste.
I also use a two peice convetec. I can't see if I have it centered if I had a one peice. Putting the wafer in without a bag first gives me a good view. I also use opaque bags. I don't want to see what's in the bag. I know what's in there . Lol.
Richard.

[Shamrock4806]

I use an adapt ring. No paste. I get seven and more days 98% of the time.

I have a recessed stoma so it's proving to be more challenging.

I don't use paste.
I also use a two piece convetec. I can't see if I have it centered if I had a one piece. Putting the wafer in without a bag first gives me a good view.

Yeah that's why I started using the sheet method as to be able to see the paste that it was close to the stoma which like you say, can't be seen with a one piece.

Plus I figured if it would leak, it would leak on top of the sheet which usually isn't the case.

My problem now is because of my recessed stoma and that micro gap around the edge where it meets the outside skin gets burned and even bleeds some. But it's been a lot better than before just pasting and pressing the one piece on, that's guessing too much and leaves a lot to chance, like missing.

I can see with the ring one can adjust it to fit, but in my experience it's been difficult to get perfect.

What I did buy is a brush on version of NewSkin, which is a liquid bandage. For waterproof, three thoroughly dried coating are necessary.

I'm going to try to use this just around the recessed stoma/skin gap then smear the non-sting paste on top using a small stir stick like used for coffee.

I wish my stoma wasn't recessed and just sticking out, would make things a lot more easier for me. I could use a ring and fill the gap from the top keeping the stoma contents away from the skin.

But because my stoma is recessed it oozes out and alongside the stoma next to the skin and is most difficult to seal.

The convex is supposed to push the stoma out, but that doesn't work all the time. Most of the time it's inside, below skin surface and I'm assuming when it does protrude into the appliance that is also causing issues along where the skin seal is.

I'm getting more days out of a bag with this better method, less leaks (none really) but it's not perfected yet.

[Mysticobra]

A recessed stoma sounds like a pain in the arse.
I specified to my surgeon. And I'm fortunate she listened and did give me a nice stoma. I did research.
But I do understand it can't be done with everyone.
Even having one that isn't it pulls itself in quite aways while working with it and makes it difficult.
I have no suggestions on a rececced one.
No experience with one. All I can offer is what I did.
Richard.

[Shamrock4806]

I applied and blow dried three coatings of New Skin in that crack next to the stoma, so far so good. I'll know after a few days if that skin heals or not.

I also bought a generic version of Flonaze which according to what I read online from an ostomy nurse, should help with the red irritated (but not damaged) skin where the adhesive sticks to the skin.

And the mad experiments continue.

Boldly going where no hospital wound care nurse has gone before.

[Shamrock4806]

Okay a follow up.

The NewSkin didn't work.

Tried Flonaze and it's been the best skin protectant yet despite it not being designed as such.

Found out the paste is water resistant, thus if the skin is weeping it will not adhere and leak remains.

Likely the reason the NewSkin failed as well, weeping skin.

Read some better info how to correctly apply stoma powder (crusting) and where (only on weeping skin), when to stop using it. (When there isn't any weeping skin).

Will be trying this next time.

So it's been 90 or so bag changes over 9 months and hopefully on the last stretch here with this thing. It's really been trying my patience because the game keeps changing as things heal up. So much bad experience, teachers (nurses) and information out there.

And my stoma is considered flush as it can stick out about 1/8- 1/4 inch usually, it's not recessed however the convex is the right approach to get it to remain stuck out. Yea I'm going to give my surgeon a call to advise he sticks the stoma out further next time he gives anyone one because this thing is a nightmare of trouble compared to others experience.

[Shamrock4806]

I'm starting to think the benefits of the sheet is it presses the paste and helps to keep it down despite weeping skin underneath.

The convex is a bit more unbalanced on top and moves a tiny bit when sleeping and moving about thus tiny cracks develop where the acid can attack the skin.

However when the convex is on top of the sheet those cracks are mitigated some, with the swelling ability of the sheet (verses none for the convex) also assist to seal micro fractures.

I can say this though, if one is feeling a small annoying consistent burning pain, it's likely a leak and best to rip it off when your stoma has gone quiet, take a shower with Dove or another moisturizer soap and slap a new bag on. The longer you let it go, the worse it gets and the harder it is to fix and heal.

[Shamrock4806]

Okay it's only day 2 and I've already sprunk a small leak, feel that burning sensation and after ripping the bag off (that Flonaze as a skin protectant made it easy) sure enough there was an irritated spot.

So I'm thinking to myself, the paste is water resistant so it's not going to bond to the weeping skin.

So this time I did the crusting method which involves stoma powder on the weeping skin only (excess blown and washed away) blow dried and then the skin protectant then blow dried some more so my finger can feel its bone dry.

Now before I was applying paste then the sheet, but I'm thinking the sheet absorbs fluids so instead I just bent over to form a valley and applied the sheet directly to the skin instead as it's flexible and the convex is not.

Now there was some gaps between the sheet hole and the stoma which I filled with no sting paste. Then enough around to level and marry to my convex.

I think this may work better because the sheet is closer to the skin and not over the water resistant paste which doesn't stick to weeping skin. The sheet is also covering some of the injured areas so hopefully this will allow them to heal.

So I see I may have not read any instructions how to use the sheets.

Because my stoma is mostly flush, it's difficult to get the output out over something so it goes into the bag. Rather it likes to pressure sideways and this loosens even good stuck on paste.

I use handheld sprayer in the shower and I aimed it sideways at paste near the skin and it resists for awhile, but eventually comes off.

So it appears I need some sort of plastic ring that is molded for my stoma, to protect and force output upwards instead of sideways.

I guess I could cast my stoma and create a mold to use as a cookie cutter to cut through two sheets and use that.

The mad experiments continue.

[Shamrock4806]

Bad move, sheet without paste underneath lasted about an hour then leaked.

So stoma powder on weeping skin only.

Then skin protectant all over the area to edges of adhesion.

Then dried thoroughly, then paste spread thin around stoma, then dried, then the sheet, then more paste, then the convex, the extra adhesive strips then the belt.

Will look into creating some sort of plastic ring for stoma.

Maybe I could use a thick barrier ring or two on top of a thin layer of no sting paste, then more paste to level and then the convex etc.

The ring should have more sideways resistance to the stoma pressure thus forcing output up and out into the bag. This is why I'm considering something made out of plastic and molded to the outline of my stoma.

We will continue another time.

[Shamrock4806]

Okay a neat trick I've learned.

It's very important to have dry, non-greasy skin around stoma. Stoma output contains oils that lubricate and if this gets on the skin (or on the paste) then simply wiping off will not do.

Best to start over and use moisturizer soap to remove the oils on the skin (or contaminated paste) then dry thoroughly.

Next take care of weeping skin with stoma powder but do not get any on the healthy skin as it will prevent adhesion by the paste.

Cover area with Flonaze aka skin protectant and lite blow dry well so finger tip feels it's dry. Not sliding which means it's wet or oily.

Next apply no sting paste in a thick ring around stoma slightly away from the stoma and press down and around to get it closer to stoma.

Now the new trick: Use something else flat to pretend to put an appliance on, squeeze down then remove. If adhesion to skin went good, half the paste will remain stuck to the skin and the other half on the garbage piece.

Any areas where the paste was fully removed from the skin needs to be cleaned, dried, powdered, protectant and half no sting paste applied again and tested using a flat stick to see if it stays stuck on. Also push paste to fill gaps and whatnot close to stoma. All the stoma output needs is to touch a small part of any skin and a chain reaction occurs where the skin weeps and causes more paste to separate from the skin. The burning gets worse and harder to cure.

Any paste that is on the stoma needs to be discarded as it will shift and block the stoma or appliance hole. It's usually wet or oily now and worthless to stick to skin.

Next comes the sheet, center hole cut to match the stoma, pressed down to get the paste as close to the stoma as possible and well adhered.

So there should be a half tube level of paste spread around the stoma with the sheet on top. This is vital to protect the skin from burns.

Next apply a half level tube of any paste (alcohol would be good as it's more flexible) and level out so when squeezed it won't cover the hole. It's only designed to fill uneven gaps really.

Slap on the bag, press down and paste shouldn't protrude over the stoma. If stoma is blocked then this increases sideways pressure between paste and skin, causing leaks.

Adhesive strips, belt and rock and roll.

There is definitely a science to this thing and after almost a year of doing it myself I think I've finally got it down. I only get very tiny leak spots when before my entire skin around stoma was bloody and raw. A frigging nightmare of poorly trained hospital staff.

Hopefully a lot of potential wound care nurses are reading about my experiences here and learning something, will save a lot of people from a lot of grief.

Remind you again I have a near flush stoma, only protrudes about a 1/8-1/4 inch out, making flat appliances worthless and convex vital, but sideways pressure problems remain and one has to sleep on their backs most of the time.