Chapter 42 ■ Neonatal Ostomy and Gastrostomy Care 297

fistula. Further discussion about pouching mucous fistula below in F8.

5. Trace hole size onto wafer. Cut hole(s) using small scissors or a seam ripper (Fig. 42.10). After cutting and

before removing the paper backing, check the fit

around the stoma and trim more if needed. Run a finger along the inside of the opening to make sure there

are no sharp edges; these can be cut or smoothed by

rubbing with the finger. It may be necessary to trim the

wafer to avoid umbilicus, groin, and so on. Cutting

small slits along the edges of the wafer may help the

barrier conform to the contour of the stomach.

6. Warm wafer in hands to promote flexibility and enhance

bonding to the skin. Avoid using a radiant heater to heat

the wafer because the amount of heat absorbed cannot

be controlled and may burn immature skin (2).

7. Press wafer to skin and hold for 1 to 2 minutes. Secure

the edges of the wafer down to the skin to improve

wear time. Avoid the use of high-tack adhesives. Pink

tape is a waterproof tape that contains zinc oxide; it is

very gentle and generally can be used safely. Other

low-tack alternatives are silicon tape or clear film

dressing.

8. Change dressing to mucus fistula using a folded 2- ×

2-inch gauze piece and low-tack adhesive or secure

with diaper or tubular elastic dressing. If the drainage

from the mucus fistula is more than can be contained

in the gauze and is interfering with the pouch adhering

or the drainage may potentially contaminate wounds or

central line sites, then the mucus fistula can be

pouched. It is always preferable to pouch the mucus

fistula separately from the active stoma to keep the stool

from contaminating the bowel anastomosis or draining

into the vagina or bladder in the case of a patient with

high imperforate anus defect with fistula. It is advisable

to discuss with the surgeon before placing both stomas

in one pouch.

G. Emptying the Pouch

1. Supplies

a. Clean gloves

b. Diaper or syringe for withdrawing stool/effluent

c. 30- to 60-mL syringe for irrigating/washing the bag

d. Tap water

2. The pouch should be emptied when it is one-third to

one-half full. Gas must also be released or vented to

prevent pulling the adhesive wafer away from skin.

Neonates generally produce large amounts of gas,

related to increased intake with sucking and crying (2).

Effluent can be drained directly into a diaper or withdrawn from the bag with a syringe. Use of two or three

cotton balls placed in an open-end pouch can improve

wear time by wicking the effluent away from the barrier

and also may facilitate easy drainage of the pouch. It is

generally not necessary to wash the pouch, but it may

be necessary to add fluid to help loosen up thick or

pasty stool. For the hospitalized neonate, measurement

of ostomy output is usually indicated.

3. Close the pouch with an integrated closure device or

rubber band.

H. Complicated Stomas and

Peristomal Skin Problems (5,9)

Table 42.3 lists complications and interventions for treating

complex stomas and common stoma problems. Note that

many of items used are not generally recommended for use

on premature neonates or neonates <2 weeks of age, but in

situations of deterioration of the peristomal skin, they are

sometimes used cautiously to prevent further deterioration

and maintain an effective seal.

I. Vesicostomy Care

A vesicostomy does not require pouching; urine drains

directly into the diaper. Care is similar to general perineal

Fig. 42.9. Measuring the stoma.

Fig. 42.10. Cutting a hole in the wafer.