Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex.

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.

Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex.

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.

Actinomycosis: a case report of two patients treated for the condition who required stoma formation.

Actinomycosis is a rare bacterial condition that is seen infrequently and no studies have examined its prevalence or incidence globally. The author, a stoma care clinical nurse specialist (CNS), found herself caring for two such patients 3 weeks apart, both of whom were diagnosed with pelvic actinomycosis. Both patients had been fitted with copper intrauterine devices (IUDs) 10 years previously and were not aware that leaving IUDs in situ for a prolonged period increased their risk of infection. This article gives an overview of the condition, with discussion around the two patients the author cared for within her own specialty; not all aspects of the condition are included as the she has no clinical experience in microbiology and is not a gynaecological CNS. The case studies show how both women presented and were treated, with interventions including emergency surgery, long-term antibiotic therapy and stoma formation. Pelvic actinomycosis is often associated with the use of an IUD, and greater awareness about the risk of leaving IUDs in situ for prolonged periods is needed among gastrointestinal, colorectal and gynaecological practitioners.

Silicone-based stoma accessories in clinical practice.

Advanced silicone technology has transformed the treatment of wounds and peri-wound skin. Recently, there has been interest in the use of silicone-based products in stoma care. Peristomal skin issues are a common problem, and can have a negative impact on the patient's quality of life, so helping the ostomate maintain good skin health is crucial. The author, a stoma care nurse, regularly sees 3-4 patients each week in her stoma care clinic with damaged or broken peristomal skin. This article explores the 'Trio' range of silicone-based accessories, discussing how these products compare with the traditional hydrocolloid, how they are applied and used. A series of case studies illustrates the circumstances in which these products may be applied.

What the patient needs to know before stoma siting: an overview.

Stoma siting is often regarded as the most important aspect of pre-operative stoma preparation (Readding, 2003; Rutledge et al, 2003), however, time spent with the patient discussing the finer points of surgery and what can be expected throughout the process is also crucial. Having the opportunity to meet with individual patients prior to surgery allows for the advanced exchange of information and the ability to discuss stoma formation from conception to ultimate patient management in its entirety. This arms the patient with the relevant information before surgery ever takes place, and prepares him or her for the time ahead. This article looks at the steps taken by the stoma care nurse (SCN) in preparing the patient for such surgery.

Dietary advice for patients with a stoma.

In the enormity of stomal surgery, dietary advice for patients is key to rehabilitation. Yet it is too often overlooked (Porrett and Joels, 1996) and patients are given conflicting advice. These patients desperately want to do what is right. They want to recover, get well and go home. They are therefore happy to follow instructions, but need to understand the rationale for them. The author believes that dietary advice is invaluable and should be offered to all new stoma patients. She also believes that, if dietary advice is presented before and after surgery, in a clear and concise manner, it will equip patients for life with their stoma. Having knowledge brings power and patients are emplowered with a good knowledge base. The formation of a stoma disrupts the normal functioning of the gastrointestinal tract and alters its reabsorptive process, not to mention its flow. Initially, having a stoma is daunting and, for the vast majority of patients, terrifying. Patients need advice from ward or stoma nurses that will give them the confidence to make independent food choices. This, however, takes time, patience and lots of reiteration. Both verbal and written information are helpful. This article sets out to provide an understanding of ostomists' dietary needs to allow healthcare professionals to provide information with confidence, as and when required.

An overview of stoma bridges and a case study on their management.

Over recent years, very little appears to have been written on stoma bridges or rods, which are additional supportive mechanisms for loop stomas. Within St Mary's NHS Trust, bridges are commonly used following the construction of a loop stoma (ileostomy, colostomy, and loop transverse colostomy), and the author has become accustomed to their presence. However, in conversing with other stoma care nurses across the country, it has become apparent that not all institutes, trusts, or other hospitals use bridges, and it would seem that some have not done so for many years. Intrigued by these devices, the author decided to take a closer look at their use, appearance and purpose. This will provide other stoma care nurses, as well as general nurses, with a better understanding of what they are and why some surgeons still use them. A short case study is also presented, discussing how a bridge was managed in the post-operative period when an appliance became insecure and the bridge was immobile and tight against the abdominal surface/plane.

Prednisolone in the management of patients with Crohn's disease.

Glucocorticoids, a type of steroid hormone, are widely used in the treatment of inflammatory bowel disease (IBD) in patients with Crohn's disease or ulcerative colitis. Many patients with these conditions are managed conservatively outside hospital, with continued support from their gastroenterologist and occasional glucocorticoid medication. However, glucocorticoids are not a long-term solution for anyone with IBD, since they carry many unwanted side-effects, and can damage body parts and function years after ingestion, particularly if the dose was high and for longer than 6 months. In the short-term, glucocorticoids can produce some very impressive results, but patients need to know the facts about them and what they should and could expect from taking this medication. This article gives an outline of one of these drugs--prednisolone--what it is used for, and the side-effects that may arise.

Colostomies and the use of colostomy appliances.

The surgical formation of a colostomy is indicated as part of the treatment of various conditions, primarily colon cancer, requiring the patient (ostomist) to wear a colostomy pouch. Today's stoma appliances bear no resemblance to those worn three or four decades ago when colostomy, ileostomy and urostomy bags were made entirely from rubber. The patient, who would have two to three bags in circulation at a time, would interchange them allowing for the washing and drying of the previous one, thus minimizing odour and potential perishing of the rubber. The design of these appliances was simple, but they were large and bulky and the outlet resembled that of a hot-water bottle stopper or a cap from an old soda bottle that required the insertion of coinage (2p) to open it. This article explores the range of colostomy appliances and management options available to the nurse when caring for patients with a colostomy.

Best practice in discharging patients with a stoma.

Pre-operative preparation and postoperative education are both essential elements for the recovery and successful discharge into the community of patients with a stoma. The ultimate goal of any stoma care nurse is to provide patients with the necessary practical skills and knowledge to return to a lifestyle they enjoyed before surgery (Abrahams, 1984). The basic pre- and postoperative planning that is required for patients who have had bowel surgery under elective conditions with a confirmed colorectal pathology, for example, rectal cancer or inflammatory bowel disease, is described below. Stomas include colostomy, ileostomy, jejunostomy and urostomy. They can either be end stomas (one segment of bowel is exteriorised), or loop stomas (two segments of bowel are exteriorised), and they may be permanent or temporary.