Moldable barrier Barriers that are adhesive and can be shaped to fill in uneven spaces; generally hold up very

well to corrosive effluent. Common types are Eakins Seals (ConvaTec, Princeton, New

Jersey), Barrier No. 54 (Nu-Hope Laboratories, Pacoima, California), and Adapt Rings

(Hollister, Libertyville, Illinois)

Caulking strips Similar to moldable barriers but come in narrow strips; they can be used to provide an extra

barrier between the edge of the stoma and the barrier. May come in contact with stoma;

soft enough that it does not injure the mucosa. Examples are Ostomy Strip Paste

(Coloplast, Marietta, Georgia), Skin Barrier Caulking Strips (Nu-Hope Laboratories,

Pacoima, California), and Adapt Strips (Hollister, Libertyville, Illinois)

Belt Elastic belt with tabs that fit to ostomy pouch of some two-piece appliances. Belt can help

maintain the appliance in place by holding it firmly to abdomen. Generally used as a last

resort when unable to obtain acceptable wear time.

296 Section VII ■ Tube Replacement

neonate is generally either an open-end pouch that allows

the passage of thick or formed effluent or a urostomy pouch

with a spout designed for drainage of urine or liquid effluent. The type of pouch and the need for accessory products

varies depending on the size of the child, the condition of

the peristomal skin, abdominal size and contours, and institutional preference. In general, it is best to keep the procedure simple and to use as few products as possible (2).

Special consideration needs to be given to the premature

infant whose skin is immature and fragile. Several companies manufacture pouches for neonates and premature

infants (Fig. 42.7). Neonatal units should have several varieties to choose from in order to meet each patient’s individual needs.

Supplies

1. Clean gloves

2. Warm sterile water or normal saline

3. Clean, soft cloth

4. 2 × 2-inch gauze

5. Appropriate-size pouch with closure device

6. Protective skin barrier and pouch

7. Other ostomy accessories as appropriate (Table 42.2

and Fig. 42.8).

8. Scissors or seam ripper

9. Stoma-measuring device

F. Applying the Pouch: Routine/Simple

Ostomies (2,6,8)

1. Remove old pouch by gently lifting up the edges and

using water to loosen while pressing down gently on the

skin close to the edge to reduce traction on the epidermis. Adhesive remover should not be used on a neonate

<2 weeks of age. Limited use of adhesive remover, followed by thorough cleansing of the area to remove any

chemical residue, is recommended only when the

adhesive bond of the barrier to the skin is so strong that

the skin might be injured during removal (2).

2. Use damp soft gauze or paper washcloth to gently

cleanse the stoma to remove adherent stool or mucus. It

is common to have a little bleeding of the stoma when

it is cleansed.

3. Wash peristomal skin with water; pat dry. Soap is not

recommended because it may leave a chemical residue

that could cause dermatitis; furthermore, many soaps

contain moisturizers that can adversely affect the adherence of the barrier to the skin. It is also not advisable to

use commercial infant wipes, because most are lanolinbased and contain alcohol (2).

4. Measure stoma(s) using stoma measuring device (Fig.

42.9). The opening generally is cut 2 to 3 mm larger

than the stoma, to limit the skin exposed to effluent. In

tiny infants, in whom the mucus fistula may be immediately adjacent to the functional stoma, one pouch

Fig. 42.7. Examples of appliances for pouching a neonate. may be sized to fit over both the stoma and the mucus

Fig. 42.6. Barrier paste applied to wafer. Fig. 42.8. Examples of ostomy accessories.