difficulty with pouch leaking, using eakin seal

I am the care giver for a wheelchair bound patient with new colostomy placed in December. We are seriously struggling with getting a pouch to stay on longer than a day. we have had 1 stay on for 21/2 days using convatec active life one piece bag and eakin seal. There are multiple problems with this situation. her stoma was placed way to low on her abdomen so that the bags fold and pull loose because she is sitting all the time and has an abdominal fold. Also her stoma is almost flush with her skin. We have tried every convex bag that I could find and all have a hard plastic ring to them so that they do not work they just aid in pulling the wafer off. I really thought we had it figured out with the new system of using eakin seal and active life bag but the past two bags have failed with leaking under the wafer and coming off. another issue is her belly button falls under the wafer so I have been using the eakin seal in her belly button and a ring around her stoma. still not working. we are extremely frustrated and don't know what else to do. there is also an area of skin irritations where the top layer of skin is off right next to her stoma. what I did the first time was use powder and glue wipes to build up a barrier prior to placing the seal because the wound is weapy and moist so having trouble getting eakin seal to stick. then after that I went with just the seal around the stoma and filling the belly button area with seal. I'm using the small ring and making it more thin around the stoma area and attempting to make it more of a flat surface to stick to. I have been warming it and following all instructions concerning use. I'm cutting around the edge of the seal to make a piece for the belly button. another problem is wrinkling of the wafer after she sits up and moves around due to her body shape and stoma placement.

my questions are
is the seal supposed to be thicker around the stoma,

is it ok to use barrier slash glue wipes in areas where the seal is not,
is it ok to layer the powder under the seal.

I am a nurse and have had experience with ostomies prior to this situation but have never had this much trouble finding a solution to these issues. I am begging for help from people who have had similar issue or have any suggestions. thanks in advance

Sorry you're having such a tough time. Have you talked to a stoma nurse about the situation? They often have bags of tricks .... many of us have had the experience of having problems that visiting nurses w/some ostomy experience couldn't solve, but then having WOCN's know what to do.... they would have a better sense about whether surgery is necessary.

I would be wary of powder under the seal though .... powder makes the wafer not stick as well.

I wonder if something on the outside might help some -- sure seals and/or an ostomy belt?

Have you tried the eakin thins? Wondering if that would make a difference?

But it sounds to me like you need to find someone who is an expert on difficult pouching situations. Hope you figure something out.

A few thoughts:

1. I agree with Dan; you need to see about having the stoma relocated, and first marked by a stoma nurse who evaluates the patient while he/she is sitting in the wheelchair so it's obvious where the skin folds are. I know that sounds crazy but it may be necessary.

2. In the meantime, yes, you can use powder anywhere under the barrier, as long as you use barrier wipes (you can also do that anywhere under the wafer) over the powder. I'd just do the one layer; too much will cause it to not stick.

3. I would also say to use a belt in the meantime, as well as the convex wafer.

4. Bottom line, you need to have the patient SEEN by a stoma nurse soon and get their take on things before the skin breaks down more.

Keep us posted and good luck. We know how frustrating it can be.

I had similar problems with my new ileo. Any time I used the wipes and Eakin rings, it was a disaster.
After working with three nurses from different organizations, we found the following to be reliable. Clean area with soap and water. Rinse with a wet wash cloth. Dry with a hair dryer set on warm. Squirt Convatec Stomahesive powder protector lightly around the base of the stoma. Blow away excess with the hair dryer. I develop blisters very easily so I also put on a very light, almost non-existent layer of Mitrazol powder around not on the stoma. Spray the area with 3m Cavilon no sting barrier film, avoid spraying the stoma. Fill the abdominal crease and the navel fold with a small bead of Convatec Stomahesive paste. After cutting barrier to fit stoma, squeeze bead of the Stomahesive paste around the inside of the ring where it will be touching skin. The paste is a substitute for the Eakins ring. Put the barrier firmly around the stoma after the alcohol smell diminshes (about 15 seconds). Don't worry if a little paste turtlenecks around the stoma. If it is more than a little just wipe it off. Click the bag onto the barrier. Use a heating pad or your hand to press the barrier against the skin. This helps the barrier gel adhere strongly to the skin. I use a hollister 2-piece drainable Velcro seal pouch. I change the bag every three to four days and the barrier every seven days.

Thanks for the tips but relocating her soma is not an option. Too many abdominal surgeries and scar tissue. Her skin is surprisingly in good shape besides one small sore area at top party above soma.

I am a fan of less is more...skin prep can often shorten wear time.

You should be able to trim off the area off the wafer that interferes by her bellybutton. I have to remove about 1/2" from mine and it doesn't affect my wear time.

Have you tried the ... the name escapes me right now... it's the 'other' Eakin. If one doesn't work for a patient the other usually does. Someone will know the name, I am sure, and post it!

I recently discovered that not all convexity wafers are the same...I need it for a stoma that can become flush but the wafer I was using wasn't very flexible and was actually pulling away when my stoma pulled in. I switched to a light convexity that had a more flexible wafer and it stays on a lot better.

I'd also suggest trying a Sure Seal (www.alpglobal.com) they'll send a couple samples with good instructions.

Is irrigation an option? If her stool is formed enough it might work.

Yes, thank you!!

I am confused about how irrigation would help. Are you talking about irrigating to stoma or the bag? Thanks for all your input.

Irrigation is something that some people w/a colostomy can do if there's enough colon left. I don't know a lot about the details (not an option for me, as I have no colon at all), but from what I've heard it takes about an hour every day or two or so.... people get themselves on a schedule. It's kind of like an enema to clean out the colon... then the rest of the day, you don't need a bag at all, just a little cap on the end of the stoma.

I think that some people w/colostomies hate the idea of having to irrigate regularly and others find it liberating to not have to wear the bag.

Here's an article about it http://www.ostomy.org/ostomy_info/pubs/Phoenix_Irrigation.pdf

Excellent advice above to try and hopefully something in there will be the answer. What a shame that the stoma had to be placed and located where it is. I have to assume the surgeon had no other option...I certainly hope that is the case. I definitely agreed with Dan until I saw your response that relocation is not an option.

Hopefully this trial and error process....(make notes to refer to of each variation you try and which appliance etc) ...will keep you focused on what to try next for successful results. Good Luck!!!!

Dear frustrated1000,
I can totally relate to your problem getting the bags to last longer than 24 hours is like winning a battle but not the war. We are dealing with our Mother and her ileostomy she had done in January and it's just been a nightmare. Not even the 3 different stoma nurses we saw and had put a bag on her from lasted 24 hours. Then we got the eakin seal which I thought was the answer to all our prayers but after the first bag the stoma nurse put on we're back to every 24 hours. I've been offered a lot of help from my post, What can we do? So many people gave me so many different options and we're trying them all. Good luck with your problem and know that the people here are the most sympathetic and helpful people I know concerning these issues. Trial and error is all I can do at this time but I'm still hopefull. Hang in there and good luck.
toritoo

I needed convexity but using the seals and/or the adapt barrier rings from Hollister didn't do enough for me.

There is a new product called Dermacol. I use it in combination with the new seals that are made by the same company. I think they are called Saltz seals. Anyway the Saltz seals look just like an Eakin Seal. You have to put the Saltz seal on first around the stoma. Then you slip the Dermacol over the stoma and the bottom of that dermacol sticks to the Saltz seal that is already surrounding the stoma. Then you put the appliance wafer on top of that. I use it and have had lots of improvement with wear time because the stool is directed away from the base of the stoma, it is kind of like the stool is forced through a narrow tunnel and is directed straight into the pouch. I hope you can benefit from this suggestion. These problems are so frustrating.