Hydocolloid breaking down on barrier

Hi,

We're new to the group as well as to the land of ostomy! My wife is a new ostomate and has an ileostomy.

During the past two weeks it's been a real trial, leaks 3 or 4 times a day until we found the correct appliance. We were using two-piece, but she has lost about half her body weight over the last 2.5 years and has a lot of loose skin which causes a fold at her stoma. That problem was solved by changing to a one piece appliance which is much more flexible.

The issue is that no matter what the brand (Coloplast lasts the longest) the edges where the cut-to-fit is made begin to turn white and curl up and eventually a leak develops. Hollister appliances begin almost right away (within hours) and Coloplast seems to last the longest. We have some extended wear samples on the way and hope they work better.

No one at the various companies I've called can give us a reason as well as the surgeon and the WCON. Has anyone ever run into this problem or heard about it? Is her stool to acidic?

We're looking for some help and we are very new at this (16 days out of surgery), but these frequent changes have got to stop, her skin just can't take much more.

Gordon and Jean Taylor

@Mom2panda...Thanks for the reply so quickly.

I've called all the companies I can think of, no one has a remedy.

Yes we use a barrier ring under the wafer. She blows through Hollister rings in about 12 hours. The Coloplast last a lot longer.

Convex barriers do NOT have enough flexibility and loosen quickly. One piece Coloplast 15521 seems the most flexible and last the longest.

The issue is NOT under the barrier, but the barrier itself...the hydrocolloid backing begins to curl at the edges where it's cut. It turns white and swells up and then begins to curl up and eventually leaks.

I've used CyMed with good success.

CyMed has a unique "micro-skin" wafer material. I have a flat abdominal surface, but the wafer is specifically designed to provide for enhanced adherence to those with dips and valleys in the topography of the skin.

I also have a recessed stoma. For me, a wafer with convexity was too rigid - the plastic "bowl" of convexity did little for me. I found that an ultra-flexible wafer was the right fit for me.

FYI: The CyMed wafer is available as a flat wafer or with convexity. CyMed uses the term "washer" instead of convexity. You can order a flat wafer or a wafer with 1 washer (light convexity) or 2 washers (regular convexity).

The Coloplast Brava line also makes a product similar to a barrier ring/seal that comes as a tube/strip - designed to fill and level areas where there is a skin dip.

I am not a fan of ostomy paste. The word is misleading. It does nothing to enhance adhesion. Ostomy paste is meant to be used like grout - to fill and level areas where there is a skin dip.

The CyMed wafer would be worth exploring. I believe the site is www.CyMedostomy.com

It takes trial and more trial to find the ostomy system best for each person. Try not to get discouraged.

- Karen -

@SeaShell

Thanks so much for the info...I'll research CyMed. My current insurance supplier does not carry them, but I'll find one that does and get some samples...

maybe try eakin seals and make sure they are funneling up around the stoma.. or inside the cut part of the wafer.
www.eakincohesiveseals.com

I have found the brava rings to break down sooner than the eakins. But go to the eakin website and they give a good description on how to use them.. you would do the same with the bravas. The key is to make sure they are kind of "funneling" up.

gordon
Have you called Convatec for help? When you call you talk to a nurse, not an order taker. They do know what they are talking about and know the products. Give them a try. I have used Convatec about 4 years with good results.

Convatec phone 800 422 8811

Dan

GordonTaylor- My appliance hydrocolloid material turns white and curls up around the cut edge too once it is exposed to output. For me, Convatec is the best because as it turns white, it at least also sort of swells. I find I absolutely cannot go without some sort of ring under my wafer. I have used Adapt, Brava and Eakin rings and find the Eakins erode the least quickly with my output. Adapt were second best. The Coloplast strips or rings eroded very quickly... sometimes not even lasting a day.

I also have the issue of my output eventually eroding any exposed ring away in 3-4 days, which leaves 1/8 inch of my skin exposed around my stoma (I need to cut the wafer opening a little bigger than my stoma as my stoma expands and contracts a lot. I don't want to strangle it). Because of the eroding issue, I cannot go longer than 3-4 days between changes. I think my output must be extra acidic too or something. Sometimes it actually makes the hydrocolloid material bubble even on the flat part away from the cut edge that is exposed to output. Thankfully it has never eaten all the way through.

I have a blog post that shows how I put an Eakin on-- http://ostomyoutdoors.com/2012/10/30/ring-around-the-stoma-my-best-defense-against-leaks/

Changing every 3-4 days doesn't seem to have a negative impact on my skin though. I use Niltac adhesive remover spray which makes peeling off the wafer much easier on the skin. This particular adhesive remover is silicone based, so it does not interfere with pouch adherence like the oil based ones do. You don't even need to wash it off with soap and water afterwards. It is really great stuff. I hope someday that it is carried by supply companies like Byram and Edgepark so that insurance might cover it, but for now I think Ostomy Secrets is the main supplier. http://ostomysecrets.myshopify.com/products/niltac-string-free-adhesive-remover-spray

Good luck!

gordon.. you can also just nuke all of these seals/rings... and just try paste. That's what I used with my first end ileo and it worked like a champ.

also are you heating up things after applying a new system. don't know if she is changing lying down or standing up.. but stay in whatever position... and then after getting everything on, blow dry on low setting for a bit of time. And then stay in that position for maybe 15-30minutes to really get things sealed on...basically no twisting or bending right after putting on the new appliance.

UPDATE: Thanks to Blueheron, I called Convatec. What a difference this company is, very refreshing.

Hollister and Coloplast acted like they didn't know what I was talking about when I call them about the barrier break down. Albeit, you are talking to a minimum wage Cust Serv agent no doubt.

Convatec has WCON's answering the phone, she knew immediately what I was talking about and is rushing some samples our way. Fingers crossed this is the answer.