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First bag change went horribly

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Posted 12/21/2014 5:05 PM (GMT 0)
So, I changed my bag with my mom today. It had not been changed for almost a week because of the bad home nurse I got. I had been feeling some burning. I took it off and my skin had a large red spot that bled a little. There were also some red bumps. My stoma had changed as well. It is not just sticking out of my stomach. It is like inside a hole in my stomach. So I had to cut the wafer (I think) into an oval. So some of my skin is exposed now. Could it get further irritated? I used stoma powder and it stuck to the red spot and also went inside that hole. Could just be regular skin irritation that will clear up but it stings and looks pretty odd especially with that hole. Also, is it normal for it to bleed some if you are wiping it and there are still stitches?
Posted 12/21/2014 6:39 PM (GMT 0)
Amanda -- so sorry you're not getting the nursing support you need right now.

I can't quite picture the "hole" you're talking about -- do you mean that the skin around your stoma is indented?

A few things that might help: it's very normal for stomas to bleed, even well after surgery. There are a lot of blood vessels very close to the skin; that's nothing to worry about.

Did you put anything on top of the stoma powder? Usually you want to "crust" it (cover it) with skin prep, because otherwise the powder is slippery and it can make the wafer not stick as well. If you have trouble with leaking and need to change again, that might help, hopefully won't be a problem.

Usually you want to cut the wafer about 1/8 of an inch around bigger than the stoma, as the stoma expands and contracts a bit. Exposed skin can get irritated -- it's good to cover it with something: a barrier ring (Eakin or Adapt etc), paste, skin prep, etc.

You have a nurse coming soon, right? Hopefully s/he can help you get a better system. Sounds like you should have someone look at your skin.

But hang in -- it sounds like you did a lot right your first time. It will only get easier (one of the very annoying things is that your stoma is hardest to deal with -- right after surgery and changing a lot -- right when you are most inexperienced).
Posted 12/21/2014 6:50 PM (GMT 0)
Thanks for the reply! I'll have to try to put something over the powder next time. I guess you could say the hole is indented but very much so. To the point where blood/ stool pools there and I need to stick like a q tip inside to clean it. And yeah a nurse is coming Tuesday so hopefully it will be a better one and they can help. Thanks again for the great tips!
Posted 12/21/2014 7:34 PM (GMT 0)
You can't leave any skin exposed or else you will get more skin burns. Is the stoma sticking out? How much?
Posted 12/21/2014 9:57 PM (GMT 0)
Amanda, I don't really have much advice to give you, as I'm pretty much at the same point as you with having a stoma, but I'm sorry you're having a tough time. I can relate!
I was very prepared for changing my bag myself before leaving hospital, but not prepared for having issues - as no one is I guess! I've been having itching around my stoma too, that I posted about a couple of days ago, but after leaving the bag on since changing (on Friday, now Sunday) it is helping. I would recommend getting a seal for it; when I started getting the rash initially (when still in hospital) I was given a seal and it helped loads.
about the bleeding, my stoma bled slightly a few days ago when cleaning. The nurse was with me and she said it's completely normal. Once it's not coming from inside the stoma it's fine. Mine was just on it, very close to a stitch I could see.
I hope this bag doesn't cause you much trouble over the next few days, and you get sorted with your nurse on Tuesday!
Posted 12/22/2014 12:44 AM (GMT 0)
If there is an indent or uneven surface around the stoma I would suggest using a thin bead of powder right around the stoma where it joins your body and then a a "barrier ring" or "seal" to level the area out, then I still put a bead of paste around the wafer hole and I never have a problem. The burning is the first indication that the output is touching bare skin so change at the first sign of that or it will be raw..
Posted 12/22/2014 1:00 AM (GMT 0)
You should not have any skin exposed- it will get irritated. So, next time- use a seal, Eakin seals are good. Or barrier paste/strips- did the hospital send anything like that home with you? If not, call the companies ASAP & they will send you free samples. You can get the #'s from the internet. Sounds like the stoma is sort of recessed- like, it's in a pit, sort of? Sunken in? I think you can use convex wafers- they push the stoma out a bit, to lift it away from the skin. I think, I've never used them! Powder is good, you puff a bunch on, then I blow off the excess with a hair dryer. Then put another layer on- blow with hair dryer. Then uusually one more good layer all around the base of the stoma, blow off again with the hair dryer. Then stick a seal over the whole thing, put on the wafer, & you're good. With a bag, of course! When you use a seal, the wafer doesn't have to be cut so exact- the seal fills in any gaps. They also make wafers that mold around the stoma- I used those the first month or so post-op, no cutting. Both Hollister & Convatec make them- samples! You either stretch the wafer to fit, or roll the edges back. Sounds like you did great though- it'll only get easier, seriously!
Posted 12/22/2014 2:50 AM (GMT 0)
Amanda,

I always had a spare wafer cut and all my supplies setup in case I needed to do an "emergency change" if something went wrong with my setup. I'm not saying that you will but you might run into a problem with your ostomy because you didn't crust the powder and need to change it.
Posted 12/22/2014 3:19 AM (GMT 0)
It sounds like your loop ileo is alot like mine very recessed. I have had more trouble with this one than I did the end ileo I had after my first surgery. I definitely think you need a convex wafer it will help the stoma stand up some. I have to build my wafer up with a Hollister adapt ring and then I use a barrier seal. This system isn't perfect as I have had leaks. I did have big problems when I first came home too and I had to go to the ostomy nurse at the wound care clinic in our local hospital because I developed a large red ring around my stoma due to ill fitting supplies. As soon as I got new supplies that ring healed right up. Believe me, I had some pity parties and crying fits dealing with this loop ileo. But it does get easier and it will be worth it in the end.
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