Conservative Treatment of Mesenteric and Hepatic Portal Venous Gas Caused by Gut-Derived Infection After Ileostomy: A Case Report.

INTRODUCTION: Hepatic portal venous gas is an extremely rare symptom of gas accumulation in the portal venous system. This disease has an acute onset, a rapid progression, and an extremely high mortality rate. This report describes a patient with mesenteric and hepatic portal venous gas caused by intestinal microbiota disturbance-induced gut-derived infection after ileostomy. The patient recovered and was discharged after conservative treatment. Nursing management of patients with mesenteric and hepatic portal venous gas is discussed. CLINICAL FINDINGS: A 76-year-old patient developed septic shock, paralytic intestinal obstruction, and mesenteric and hepatic portal venous gas after undergoing ileostomy. DIAGNOSIS: Mesenteric and hepatic portal venous gas was diagnosed on the basis of abdominal contrast-enhanced computed tomography findings. INTERVENTIONS: The treatment plan included early control of infection, early identification and nursing care of gut-derived infection caused by intestinal microbiota disturbance, early identification of paralytic intestinal obstruction, relief of intestinal obstruction and prevention of intestinal ischemia, and early nutritional support. OUTCOMES: On day 18 of hospitalization, the patient was transferred to the general ward and resumed eating, producing gas, and defecating. His abdominal signs and infection indicator levels were normal. On day 27, the patient was discharged home. CONCLUSION: This case provides an in-depth understanding of the care of patients with mesenteric and hepatic portal venous gas and emphasizes the important role of bedside nurses in evaluating and treating these patients. This report may help nurses care for similar patients.

Patient-centred stoma care support: ileostomy patients.

Stoma patients require continuous support throughout their entire journey with a stoma. Although many Stoma Care Services across the UK offer patient follow-up pathways, there is not one unified pathway. Patients may not be prepared for life with a stoma because, depending on their stoma type, they will have specific needs, and if patients and healthcare professionals are not prepared to manage these stoma-specific needs, complications and hospital readmissions may occur, worsening patients' outcomes and quality of life. Ileostomy patients are known to be more likely to experience complications, including hospital readmissions, and therefore, special care should be taken when preparing these patients for life with a stoma. They should be informed and educated to prevent complications, and if this is not always possible, thye should at least be able to recognise and manage early signs and symptoms of complications. This will empower them to self-care and know when to seek medical attention.

Effects of a perioperative educational pathway on ostomy self-care, level of independence and need for visiting nurse services: a comparative observational cohort study.

AIM: Most new ostomy patients are not able to manage ostomy self-care when they are discharged and rely on visiting nurse services for ostomy care. The aim of this study was to determine if a perioperative ostomy educational pathway increases the level of independence and decreases the need for visiting nurse services in new ostomy patients. METHOD: A prospective longitudinal study was conducted between July 2018 and February 2020. Patients who received a colostomy or ileostomy and were treated on the surgery ward were included. Patients who followed a perioperative ostomy educational pathway were compared to a historical control group. The primary outcome measure was the level of independence in ostomy care and the need for visiting nurse services. RESULTS: After discharge, 67.6% of patients in the intervention group (n = 244) were able to independently perform ostomy care and were therefore not relying on visiting nurse services, compared to 15.2% of the patients in the control group (n = 33). The need for visiting nurse services was higher in patients aged ≥70 years (OR 3.20, P < 0.001), those who did not attend the preoperative practice session (OR 3.02, P = 0.002), those with a history of transient ischaemic attack (OR 10.22, P = 0.045) and those with mild cognitive impairment (OR 28.98, P = 0.002). CONCLUSION: A perioperative ostomy educational pathway effectively increased the level of independence and decreased the need for visiting nurse services in new ostomy patients.

Complicações em estomias intestinais e urinárias: revisão integrativa / Complications in intestinal and urinary ostomy: integrative review

Objetivo: sintetizar o conhecimento produzido na literatura nacional e internacional sobre as complicações em estomias intestinais e urinárias. Método: Revisão integrativa realizada nas seguintes bases de dados: Index to Nursing and Allied Health Literature(Cinahl), Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs), Banco de dados em Enfermagem (BDENF), EMBASE, PUBMED (National Library of Medicine) e Web of Science (Clarivate Analytics). Foram incluídos estudos disponíveis em sua totalidade no período de 2006 a 2015. Resultados: Foram selecionados 23 estudos em quatro categorias temáticas: fatores de risco para complicações, tipos de complicações e manejo, qualidade de vida e assistência multiprofissional. Conclusão: as ileostomias tendem a apresentar mais complicações. Complicações precoces em destaque são as necroses e sangramentos e as tardias, hérnias seguidas por prolapso e dermatites

Objective: to synthesize the knowledge produced in the national and international literature on complications in intestinal and urinary stomas. Method: Integrative review carried out in the following databases: Index to Nursing and Allied Health Literature (Cinahl), Latin American and Caribbean Literature in Health Sciences (Lilacs), Database in Nursing (BDENF), EMBASE, PUBMED ( National Library of Medicine) and Web of Science (Clarivate Analytics). Studies available in their entirety from 2006 to 2015 were included. Results: 23 studies were selected in four thematic categories: risk factors for complications, types of complications and management, quality of life and multidisciplinary care. Conclusion: ileostomies tend to present more complications.Early complications highlighted are necrosis and bleeding and late ones, hernias followed by prolapse and dermatitis.

Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary.

PURPOSE: This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. METHODS: Scoping review and generation of evidence and consensus-based clinical guidelines. SEARCH STRATEGY: The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. FINDINGS/CONCLUSIONS: This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

Overview of stoma care for community nurses.

This article explores nursing care for stoma patients, with a focus on colostomies, while providing some broader information covering a multitude of topics that relate to any type of stoma. Nurses must be aware of various factors when caring for stoma patients, as the latter will not always be in touch with their specialist stoma nurse. Therefore, if a community nurse visits more often, they can make a difference with their knowledge and care. Complications are not uncommon, and it is important the correct advice is given on diet, exercise, avoiding complications such as parastomal hernia through certain techniques, medications and aids and appliances. SecuriCare and the Royal College of Nursing have produced clinical nursing standards for the stoma nurse, and these are also relevant to community nurses. A pharmacist can give more specialist advice on medications, a GP can prescribe for infections, and a stoma nurse can provide specialist expertise to the nurse and patient alike, but the community nurse is at the frontline with a community patient. Therefore, they should be equipped with the knowledge and care expertise, so they can know when to act by referral to the appropriate professional, or give the appropriate care and advice. The patient will also have psychological needs to consider, which may require referral if these are beyond the specialist stoma nurse's or community nurse's abilities.

Telemedicine in postoperative follow-up of STOMa PAtients: a randomized clinical trial (the STOMPA trial).

BACKGROUND: A stoma has severe impact on the patient's quality of life (QoL). Postoperative home community follow-up by teleconsultation (TC) and stoma nurses may reduce the burden of travel and improve QoL. METHODS: A university hospital and five district medical centres participated. Patients with a stoma were randomized to follow-up by either TC (intervention) or hospital (control). Stoma nurses performed the clinical examination at the TC studio, aided remotely by hospital nurses and surgeons. The primary endpoint was the EQ-5D™ index score; secondary endpoints were the Stoma Quality-of-Life Scale, the OutPatient Experiences Questionnaire, and use of hospital resources. RESULTS: A total of 110 patients were randomized to hospital (58 patients) or TC (52) follow-up; 64 patients (hospital 38, TC 26) were followed for more than 12 months and 246 consultations (hospital 151, TC 95) were performed. There were no differences in QoL: EQ-5D™ index score (P = 0·301) and EQ-5D™ visual analogue scale (VAS) score (P = 0·775); Work/Social Function (P = 0·822); Sexuality/Body Image (P = 0·253) and Stoma Function (P = 0·074). Hospital follow-up performed better for organization of care (staff collaboration, P = 0·004; met same persons, P = 0·003) and communication (surgeon understandable, P < 0·001; surgeon caring P = 0·003). TC did not increase the number of hospital consultations (P = 0·684) and reduced the number of journeys of more than 8 h (P = 0·007). CONCLUSION: Telemedicine follow-up by stoma nurses did not improve the QoL of patients, but decreased the readmission rate and burden of travel. Registration number NCT01600508 ( https://www.clinicaltrials.gov).

ANTECEDENTES: Un estoma tiene un gran impacto en la calidad de vida (quality of life, QoL) del paciente. El seguimiento postoperatorio comunitario a nivel del hogar del paciente por Tele Consulta (TC) y enfermeras especializadas en estomas puede reducir la carga de viaje y mejorar la calidad de vida. MÉTODOS: Un hospital universitario y cinco centros médicos de distrito participaron en el estudio. Los pacientes con estoma fueron asignados al azar para el seguimiento mediante TC (intervención) o en el hospital (control). Las enfermeras de estomas realizaron el examen clínico en el estudio de TC, con la ayuda remota de enfermeras y cirujanos del hospital. El objetivo final primario fue la puntuación del índice EQ-5D, los objetivos finales secundarios fueron la Escala de Calidad de Vida del Estoma, el Cuestionario de Experiencias Ambulatorias y la utilización de recursos hospitalarios. Se utilizaron análisis de la varianza (ANOVA) para comparar los grupos. RESULTADOS: Un total de 110 pacientes fueron asignados al azar para el seguimiento en el hospital (n = 58) o por TC (n = 52), 54 pacientes (hospital n = 38, TC n = 26) fueron seguidos durante > 12 meses; se realizaron 245 consultas (hospital n = 151; TC n = 94). No hubo diferencias en la QoL; puntuación del índice EQ-5D (P = 0,30); escala analógica visual (P = 0,77); trabajo y función social (P = 0,82); sexualidad y cuerpo (P = 0,25) y función del estoma (P = 0,07). El seguimiento hospitalario funcionó mejor en la organización de la atención (colaboración del personal P < 0,01; seguimiento por la misma persona P < 0,01), comunicación (cirujano comprensible/afectuoso, P < 0,01). La TC no aumentó las consultas hospitalarias (P = 0,68) y redujo > 8 horas de viaje (P < 0,01). CONCLUSIÓN: El seguimiento por telemedicina realizado por enfermeras especializadas en estomas no mejoró la QoL de los pacientes, pero disminuyó los reingresos y la carga de los viajes.

Intervenção de enfermagem à pessoa idosa com ostomia de eliminação intestinal e família em contexto de cuidados de saúde primários / Nursing intervention for the elderly with intestinal elimination ostomy and family in the context of primary health care

O envelhecimento populacional é uma tendência a nível global, refletindo-se na saúde dos indivíduos e conduzindo a um aumento de doenças crónicas. Estas apresentam-se com maior incidência em pessoas cuja idade é de 65 anos ou mais. Em Portugal o cancro do colon e reto é a doença que se confronta com maior número de novos casos anuais, com cerca de 10 270 (WHO, 2018), e é a principal razão para a existência de ostomias de eliminação intestinal (OEI) (Barata, 2010), estimando-se cerca de 20 000 pessoas (Farmácias Portuguesas, 2020), sendo a OEI predominante (Barata, 2010). A presença de uma OEI, especialmente numa pessoa idosa (PI), requer competências, tanto do portador como das suas familias, tornando-se a intervenção de enfermagem essencial para a recuperação e melhoria da qualidade de vida. Após a cirurgia, estes doentes são referenciados para os cuidados de saúde primários, sendo constatado, que os enfermeiros deste nivel de cuidados, nem sempre estão preparados, com o nivel de conhecimentos necessários para poder dar resposta às expectativas destas pessoas. Sendo a relação de ajuda indissociável da intervenção de enfermagem, foi elaborado o projeto "Intervenção de enfermagem à pessoa idosa com ostomia de eliminação intestinal e família em cuidados de saúde primários", com o intuito de ajudar a suprimir as lacunas existentes. Este trabalho, resulta do percurso delineado no projeto e implementado por nós ao longo do estágio. Para a sua concecução, utilizámos a metodologia do projeto, assente no modelo conceptual de défice de autocuidado de Orem. Tivemos como objetivos: desenvolver competências como mestre e enfermeira especialista na intervenção de enfermagem à pessoa idosa com ostomia de eliminação intestinal (PIOEI) e família; envolver a equipa multidisciplinar na promoção do autocuidado à PIOEI e família. O resultado deste percurso permitiu-nos: o desenvolvimento de competências como mestre e enfermeira especialista, nomeadamente na prestação de cuidados à PIOEI e suas familias; a realização de duas sessões de formação à equipe de enfermagem de um agrupamento de centros de saúde (ACES), contribuindo desta forma para a capacitação dos enfermeiros, nos cuidados a prestar a pessoas idosas com OEI e família; elaboração de um manual de boas práticas que foi disponibilizado aos enfermeiros da unidade de cuidados na comunidade (UCC) e aos enfermeiros do ACES que participaram na formação.

Population ageing is a global trend, reflecting on the health of individuals and leading to an increase in chronic diseases. They have a higher incidence in people whose age is 65 years or older. In Portugal colon and rectum cancer is the disease that faces the highest number of new annual cases,, with about 10 270 (WHO, 2018), and is the main reason for the existence of intestinal elimination ostomies (IEO) (Barata, 2010),with an estimated 20 000 people (Portuguese Pharmacies, 2020), with the predominant IOE (Barata, 2010). The presence of an IEO, especially in an old person (OP), requires competencies, from the carrier and their families, making it the essential nursing intervention for the recovery and improvement of quality of life. After surgery, these patients are referred to primary health care, and it is found that nurses at this level of care, are not always prepared with the necessary level of knowledge, to be able to meet the expectations of these people. Since the relationship of help is inseparable from the nursing intervention, the project "Nursing intervention to the old person with intestinal elimination ostomy and family in primary health care" was designed, in order to help eliminate existing gaps. This work results from the path outlined in the project and carried out by us throughout the internship. For its design, we used the project methodology, based on Orem's conceptual self-care deficit theory. We had the objectives: to develop competencies as a master and nurse specialist in the nursing intervention to the old person with intestinal elimination ostomy (OPIEO) and family; to involve the multidisciplinary team in the promotion of self-care to the OPIEO and family. The result of this journey allowed us to: the development of skills as a master and specialist nurse, namely in the provision of care to OPIEO and its families; the realization of two training sessions to the nursing team of a Group of Health Centers (GHC) in Lisbon, thus contributing to the training of nurses, in the care provided to the old person with IEO and family; a guide was prepared and made available to the Community Care Unit nurses and GHC nurses who participated in the training.

Effect of Ostomy Care Team Intervention on Patients With Ileal Conduit.

PURPOSE: The purpose of this study was to investigate the effect of a nurse-led multicomponent intervention on ostomy-related complications, self-efficacy, and health-related quality of life in patients with an ileal conduit. DESIGN: Randomized controlled trial. SAMPLE AND SETTING: Forty-six patients who underwent radical cystectomy and creation of an ileal conduit participated in the trial; data were collected over a 6-month period. The study setting was Shanghai Pudong Hospital, affiliated with Fudan University, located in Shanghai, China. METHODS: Participants were randomly allocated to an experimental or control group. Participants in the control group received routine care over a 6-month period following ostomy surgery, while those in the experimental group received a nurse-led, multicomponent, structured intervention delivered by an ostomy care team. The Chinese language versions of the Stoma Self-Efficacy Scale (SSES) and the City of Hope Quality of Life-Ostomy (COHQOL-O) questionnaire were used to assess self-efficacy in stoma care and health-related quality of life. Ostomy-related complications including peristomal moisture-associated skin damage and uric acid crystal deposits in the peristomal area were also assessed. Fisher's exact test was used to compare the incidence of ostomy-related complications between the 2 groups. Independent-samples t tests were used to compare SSES and COHQOL-O scores. RESULTS: No statistically significant differences were found between demographic characteristics of the control and experimental groups. After 6 months, the incidence of complications was significantly lower in the experimental group as compared to the control group (4.35% vs 30.43%, P = .047). In addition, the mean SSES score was significantly higher in the experimental group (indicating greater self-efficacy in stoma care) (107.13 ± 11.87 vs 85.65 ± 12.87, P = .000), and the mean COHQOL-O score was also significantly higher in the experimental group, indicating higher health-related quality of life (154.48 ± 16.01 vs 138.26 ± 13.42, P = .001). CONCLUSION: The nurse-led multicomponent intervention provided by the ostomy care team reduced ostomy-related complications and improved the self-efficacy level and health-related quality of life in persons with a new urostomy.

CE: Stoma and Peristomal Skin Care: A Clinical Review.

: Nursing students who don't specialize in ostomy care typically gain limited experience in the care of patients with fecal or urinary stomas. This lack of experience often leads to a lack of confidence when nurses care for these patients. Also, stoma care resources are not always readily available to the nurse, and not all hospitals employ nurses who specialize in wound, ostomy, and continence (WOC) nursing. Those that do employ WOC nurses usually don't schedule them 24 hours a day, seven days a week. The aim of this article is to provide information about stomas and their complications to nurses who are not ostomy specialists. This article covers the appearance of a normal stoma, early postoperative stoma complications, and later complications of the stoma and peristomal skin.

Ileostomy Care: A Guide for Home Care Clinicians.

This article focuses on the care and management of patients living with an ileostomy. Due to shortened hospital stays, patient teaching related to self-care of ostomies has shifted from the hospital to the home setting. It is important for home care clinicians to be knowledgeable about all aspects of ostomy care. Patients with ileostomies are particularly prone to peristomal skin problems, as well as fluid and electrolyte and nutritional imbalances. This article reviews the anatomy and physiology of the gastrointestinal tract, indications for the creation of an ileostomy, and prevention and treatment of early and late complications. Practical advice on ileostomy care and patient teaching is provided.

Care of the stoma: complications and treatments.

Quality patient education of how to care for their stoma improves patient outcomes and enhances quality of care and efficacy. There is a need for home visits to assist ostomates with rehabilitation of their stoma formation, as they often feel stigmatised and are likely to withdraw from social activities. It has previously been highlighted that community care is often the weakest link in rehabilitation, highlighting the need for effective teamwork and collaboration between stoma nurse specialists and community nurses. This article will focus on some of the more common complications of stomas which will be seen in the community setting, how to treat these conditions and when patients should be referred to the specialist stoma care nurse.

Novel Pouching Techniques for the Neonate With Fecal Ostomies.

BACKGROUND: Neonatal ostomy management is challenging even under the best circumstances. When complex circumstances are encountered, creative pouching techniques must be employed. CASES: This article describes management of 5 neonates with problematic ostomies. CONCLUSION: Maintaining a neonatal pouch seal at times requires using modified adult pouching products; however, caution should always be used due to the fragility of this patient population.

Clinical and Economic Burden of Peristomal Skin Complications in Patients With Recent Ostomies.

PURPOSE: The purpose of this study was to estimate the risk and economic burden of peristomal skin complications (PSCs) in a large integrated healthcare system in the Midwestern United States. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: The sample comprised 128 patients; 40% (n = 51) underwent colostomy, 50% (n = 64) underwent ileostomy, and 10% (n = 13) underwent urostomy. Their average age was 60.6 ± 15.6 years at the time of ostomy surgery. METHODS: Using administrative data, we retrospectively identified all patients who underwent colostomy, ileostomy, or urostomy between January 1, 2008, and November 30, 2012. Trained medical abstractors then reviewed the clinical records of these persons to identify those with evidence of PSC within 90 days of ostomy surgery. We then examined levels of healthcare utilization and costs over a 120-day period, beginning with date of surgery, for patients with and without PSC, respectively. Our analyses were principally descriptive in nature. RESULTS: The study cohort comprised 128 patients who underwent ostomy surgery (colostomy, n = 51 [40%]; ileostomy, n = 64 [50%]; urostomy, n = 13 [10%]). Approximately one-third (36.7%) had evidence of a PSC in the 90-day period following surgery (urinary diversion, 7.7%; colostomy, 35.3%; ileostomy, 43.8%). The average time from surgery to PSC was 23.7 ± 20.5 days (mean ± SD). Patients with PSC had index admissions that averaged 21.5 days versus 13.9 days for those without these complications. Corresponding rates of hospital readmission within the 120-day period following surgery were 47% versus 33%, respectively. Total healthcare costs over 120 days were almost $80,000 higher for patients with PSCs. CONCLUSIONS: Approximately one-third of ostomy patients over a 5-year study period had evidence of PSCs within 90 days of surgery. Costs of care were substantially higher for patients with these complications.

Implementation of an Evidence-Based and Content Validated Standardized Ostomy Algorithm Tool in Home Care: A Quality Improvement Project.

Many nurses have limited experience with ostomy management. We sought to provide a standardized approach to ostomy education and management to support nurses in early identification of stomal and peristomal complications, pouching problems, and provide standardized solutions for managing ostomy care in general while improving utilization of formulary products. This article describes development and testing of an ostomy algorithm tool.

Perceived Barriers and Home Care Needs When Adapting to a Fecal Ostomy: A Phenomenological Study.

PURPOSE: The aim of this study was to determine perceived barriers to adaptation to life with a fecal ostomy based on the Health Belief Model and to reveal home care needs related to these perceptions. DESIGN: Phenomenological study. SUBJECTS AND SETTING: Twelve participants undergoing ileostomy or colostomy within 3 months of data collection participated in the study. The participants were recruited from Stomatherapy Outpatient Clinic of Dokuz Eylül University Hospital. Their mean age was 54.41 ± 19.14 years (mean ± SD). Eight (67%) underwent ostomy surgery 2 to 3 months prior to study participation; 9 (75%) underwent stoma surgery for the treatment of colorectal cancer, 5 (42%) had a temporary stoma, and 8 also received chemotherapy for the management of an underlying malignancy. METHODS: A semistructured interview form was used to collect data, and obtained data were analyzed with inductive content analysis. The questions were based on the Health Belief Model and were directed at identifying challenges to adaptation to life at home and home care needs in patients with stoma. RESULTS: Inductive content analysis identified 4 main themes: "restriction of daily life activities"; "factors affecting adaptation to stoma"; "need for health professionals"; and "emotional effects." The theme, need for health professionals, was expressed by the highest number of the participants. The respondents explained that services from ostomy nurse specialists should begin in the hospital and continue into the home. Participants suggested that ostomy nurses are needed to improve self-care skills via telephone contact and home visits. They also expressed the need for nursing interventions for the management of adverse effects associated with chemotherapy. CONCLUSIONS: Individuals experience physical, mental, and social barriers when adapting to live with a new stoma and when receiving chemotherapy for underlying cancer. Additional services from ostomy nurses are needed to aid patients when adapting to these challenges.

Safe management of ileostomates with high-output stomas.

An ileostomy is where the small bowel is diverted to the abdominal surface resulting in the formation of a stoma. An Ileostomy can be temporary or permanent and produces loose faeces. Some ileostomates can develop high output in the early postoperative stage. Most will resolve, some will require ongoing treatment and management. While patients are monitored closely according to protocol in hospital once discharged into the community, there appears to be little standardisation. A literature search revealed that existing guidelines are for management of patients in the acute care setting. However, if not adequately prepared and monitored, patients with prolonged high output are at risk of complications including dehydration, acute kidney injury and malnutrition. This article discusses the development of a guideline aimed at improving education, monitoring and ultimately improving outcomes for patients with high-output stomas in the community.

Evaluation of a new ostomy mouldable seal: an international product evaluation.

A new mouldable seal, Brava® Protective Seal, was evaluated by patients on aspects related to residue, durability, and preference. A total of 135 patients from four countries participated (Denmark, Germany, Japan and the USA) and the new product was compared to the patients' usual pouching systems. Less residue and easier skin cleansing was observed, which may benefit patient quality of life. The possible benefits of less residue for peristomal skin health need further investigation.