Peristomal Moisture-Associated Skin Damage and Independence in Pouching System Changes in Persons With New Fecal Ostomies.

PURPOSE: The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients. DESIGN: Retrospective review of medical records. SUBJECTS AND SETTING: The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014. METHODS: Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis. RESULTS: Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002). CONCLUSIONS: Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.

Management of irritant contact dermatitis and peripherally inserted central catheters.

Cutaneous skin changes are common in patients undergoing treatment for cancer. However, changes in central line care, maintenance practices, and chemotherapy protocols in the early 2000s may have led to the development of a common problem of irritant contact dermatitis (ICD) at peripherally inserted central catheter (PICC) insertion sites. Repeated exposure to chlorhexidine gluconate topical antiseptic solution, used in the general dressing care and maintenance with PICCs, may be the leading contributor to the development of ICD at the insertion site. A number of additional factors theoretically contribute to the development of ICD at the PICC insertion site in patients receiving chemotherapy. In this article, ICD will be defined, incidence and potential risk factors will be identified, and diagnostic framework will be explored; in addition, pathophysiology, onset, presentation, evaluation, and differential diagnosis of ICD at PICC sites will be analyzed. Finally, a synopsis of three different treatment approaches from healthcare facilities in Canada as well as implications for nursing practice and research will be presented.

Early Peristomal Skin Complications Reported by WOC Nurses.

PURPOSE: The range of peristomal skin complications reported in the literature varies from 10% to 70%. Inconsistent terminology as well as a lack of a standardized tracking tool may account for this variability. The purpose of this study was to describe peristomal skin complications seen by WOC nurses over a 1-year period using a standardized data collection tool and using the peristomal terminology developed by the WOCN Society. METHODS: A prospective research design was used to describe peristomal skin complications of ostomy patients seen within the first 2 months of ostomy surgery by WOC Central Virginia Affiliate nurses. The WOC nurses completed a peristomal skin complication form on each ostomy patient that was seen within 2 months of the original ostomy surgery regardless of whether or not he or she had a peristomal complication. Descriptive statistics were used to summarize data. SUBJECTS AND SETTING: Twelve WOC nurses saw a total of 89 patients over a 12-month period. Subjects had a median age of 61 years (range, 1-91 years). The sample included 46 females and 43 males. All patients were seen in the central Virginia area. Thirty-two patients were seen in hospital, 31 were seen in a home health setting, and 26 were seen in outpatient clinic. RESULTS: Forty-two patients (47%) had peristomal complications. The types of ostomies seen were 37 colostomies, 33 ileostomies, and 15 urinary conduits. Thirty-one patients had chemical damage to the peristomal skin (irritant dermatitis), 5 had mechanical injury, and 4 had Candida infections, 1 had an allergic reaction, and another had pyoderma gangrenosum. CONCLUSIONS: Research studies that describe peristomal skin complications over time and over multiple settings are limited. A central data repository using a standardized tool may be one way to monitor them and then begin to look at standardized evidence-based peristomal skin care.