First real leak, barrier ring failed to hold the line

I know how the first leaks made everything confusing. Here's my insight, although I can't answer al your questions.
I would blow away or lightly brush away excess powder rather than using something wet.
I am not sure if the irritation has created any holes or craters, but if so, you should fill them with powder and dont worry about cleaning out old powder when you change later. I never used skin prep outside of the hospital - the insurance padi for either powder or skin prep.
What happens if you don't use the skin prep?
Could you use the skin prepe where you re not powdering?
All of my changes involved washing the raea with water flow, and drying throughly and gently (just shower flow). I then went through my routine onto clean skin, rather than applying new powder on top of old skin prep or whatever.
The eakin and holister rings are essentially the same product, different compositions and some people are more compatible with one than the other. I used eaken sucessfully. Sometimes it did get attacked my stool moisture. You could try the eaken and see how it works for you.
I never used sure seals, but other peopel here will chime in about it.
Leaks are something that get everyone quite ruffled. I had 3-4 leaks a day between my 3rd and 6th week after the first OP, and the only once in a while for the next 10 months. I decided that I wold handle it qickly as a practical, not an emotional matter (which it was in the beginning), and it was definitely an attitude that proved to be an excellent survival technique.

1. I am confused about how to use powder to heal skin irritation- what we have been doing is to powder it liberally onto the irritated skin, wait 30 seconds, and then dab those skin prep wipes on top, while also using those wipes to wipe off excess powder. Is that right or wrong? Does one then wait another 30 s for the protective wipe film to dry, before putting in the wafer? I have an appt with a stoma nurse tomorrow.

For very minor skin irritation, all you need to do is apply a little powder then wipe it "all" away. A little stays behind in your pores and that's enough for minor skin irritation. It sounds like yours is a bit beyond that (e.g. is the irritated skin weeping at all?) and if so that is when you want to "crust", meaning apply powder, then prep wipe, then a little more powder, then more prep wipe. Heidi describes the crusting method in a bit more detail in this blog post (you can most likely ignore the stuff about Duoderm, just Ctrl-F for "crust") ostomyoutdoors.com/2013/04/01/using-duoderm-to-protect-peristomal-skin/

Always wait ~30 seconds for the prep wipe to dry on your skin before applying a wafer or barrier ring, whether you're crusting with powder or just using a prep wipe.


2. Do you just keep putting on new powder after each change, or do you first check if the film created by last application of the protective wipe has fallen off? How do you know for sure if it is stil there?

If you still see a crust of powder on top of the irritated area you can leave it be. If it's under a barrier ring I can imagine it might still be stuck there but otherwise it will probably come off. Remember there's supposed to be powder down there under the prep "film" so if you can *see* the skin irritation clearly, then you probably should do your crusting routine again.


3. It looks like my stoma has shrunk enough to let me move down to at least one smaller flange size (I use a two piece Hollister system right now)- would a smaller flange size make for a more managable adhesion of the wafer, esp. given that Ihave so little room to work with between the stoma dand the opened, healing midline incisision?

Question: are you cutting off center because the adhesive material in the center of the wafer itself is overlapping with your midline incision? Or is it only the tape on the edges of the wafer that interfere with your incision? Especially since you are not super active yet, I would recommend cutting your wafer in the center, and trimming away tape from the edges in order to avoid your incision. Again, I learned this from Heidi (and a few others on the board here) but you don't really NEED the tape on the outside of the wafer. It help stabilize things a bit so if you do a lot of twisting and moving around it supports your wafer and increases wear time, but it's much more important for the center of the wafer where the hardcore adhesive is to be anchored and applied properly. You could also try the next flange size down, I had a Hollister "pediatric" wafer in the hospital as my nurse called it and it is indeed a little smaller in total size in addition to a smaller flange. How big is your stoma now and what size flange are you using?


4. Many if you swear by the Eakin ring- would that help matters vs the Hollister barrier ring?

IDK. It very well might! I think it's all body chemistry, some people's outputs break down the Eakin faster than the Hollister or vice versa. Give it a try.


5. What exactly is this "sure seal" some of you seem to use? Is it something in addition to the wafer, barrier ring etc? is it compatable with Hollister or any wafer system or only certain makes?

It's compatible but I've never used it so I can't give much more information. Especially if you choose to go the route of cutting down the outer tape on your wafer the Sure Seal might be a good option for added security.


ps, I hear you about the belt. I didn't even have an open incision, just the laparoscopic incisions, and I found the belt irritated them way too much to wear.

Thanks everybody- great stuff. bDereh- no holes and craters yet (nor weeping) in the irritated areas- just a redder area and possibly a small blister like spot- well a small patch of skin that looks like a little patch now. Liz- thanks for so much detail and the links. I see what you and uCWhat? mean re. the tape not being that important around the wafer. It just feels creepy to actually see the barrier ring outer edge there when there is no tape. I am presently using a 2-1/4"/57 mm Holister 2 piece flange and am going to ask my stoma nurses what size they think I can now move down to. My stoma is presently about 1" diameter and I have been doing 1-1/4" cutouts; one stoma nurse did 1-1/8" the other day but then trimmed it a bit so I think 1-1/4" cutout leaves the 1/8" gap for the barrier ring to fill.

I would love to dispense with the stoma belt but I do have this feeling that the leak the other day may have been influenced by going all day without the belt, as it seems to pull the wafer edges more flush to the skin.

Hmm, didnt even think about the pick the poison aspect. BTW I just saw your new thread- congrats on handling your first full blown leak- blowout more like it?- so well. My WOCNs today suggested that going smaller would lessen leak risk because there wold be less binding issues when bending etc. about to pkace next month's inventory, so will need to decide now.

Oh, I think the main reason I had the leak was because i used the powder without dabbing on the skin protector film afterwards... Now I finally understand the procedure and so hopefully this was a one off event.

Post Edited (Probiotic) : 6/6/2013 11:19:21 AM (GMT-6)