Iliostomy bag not sticking/leaking

Ok, so I'm a dsp and my client has an iliostomy. He is now to the point where his skin is extremely raw from the leaking. Sometimes it bleeds just by touching it. I don't know the name of the specific bag he uses, but it's by hollister. So we've been having problems getting the bag to seal and not leak. Right now a bag is lasting him 2-4hrs if that. It used to last him about 4 days. It seems to really start leaking after eating. Not sure if it's because that's when he really starts to go. Mind you this is my first experience with anything like this and I've only been working there for 3 months. So we used to be able to just put the bag on and itd stay. Then when he'd start to get raw we'd use stoma powder and a barrier wipe just once. Then we started using the adapt paste. But the bag would start leaking so soon that the paste would stick to the skin. Mind you the skin is so raw it hurts him badly to peel the paste off. So we finally got all the paste off and the area cleaned. Now we're told to not use the paste but make layers of the stoma powder and barrier spray but that just leaves thick layers and the bags still not staying. The layers start flaking and we peel those off and leave the rest. We also warm the sticky parts with a blow dryer and hold a heating pad on it for 15 minutes after applying.Anyone have any advice? We're desperate to get this figured out. Thanks!

He has an appointment with an ostomy nurse today. What do you mean by same size appliance? Like bag? If so his bags are the kind that you cut out the right size for his stoma. We've tried making them bigger and smaller, and nothings working. A dsp is a direct support professional. I worked with people with special needs/ developmentally disabled.

He had a surgery about 3 weeks ago. I don't know what the surgery was called, but basically his stoma kept protruding out and was long like 3 inches or more. So they did a surgery I think to make it smaller. Before he had the problem with the stoma protruding out like that it would stick out about 1/2 to 3/4 of an inch. Now that's how much it sticks out. He's very skinny. Maybe 100 pounds soaking wet. He has gained a small amount of weight as he used to be in boys XL pants/underwear and now he's in mens small. This is an adult male btw.

Most of the time the output is watery, or diahrea like consistency. What foods can he eat to help thicken it? We unfortunatley cannot change his medications.

We haven't used adhesive remover. The problem is the past we used stuck on and we couldn't get it off and the stoma powder we're building layers with seems to be interfering with the adhesion, but that's what the ostomy nurse told us to do.

I really don't know what to do because we're very limited on what we can do. Basically we have to follow any directions a dr/nurse gives us because this is similar to a group home situation. We can't do anything with out a dr/ nurses order. I am just trying to get some ideas so my boss can mention it to his dr or ostomy nurse to see if they're willing to try it.

Thanks so much for the help so far!

The surgery to refashion the prolapse (it sounds like that's what he had) could well mean a completely different bag is needed. Sorry if I'm confused by the time frame, but did the leaks start after this last surgery or before?

A convex bag may well help, especially if the leaks started after the prolapse was corrected/the stoma was shortened. I'm very skinny and need a convex bag. I also need tape, because I'm thin but my stomach bloats outwards, and I have a scar as well, so the bag doesn't have a flat surface to stick to. I use Brava elastic tape.

Loperamide is a very safe medication used to slow output. If you or your client can consult his doctor, it may be he can be prescribed it, as it has virtually no side effects (only constipation if too much is taken - but obviously some constipating effect is what's desired!). Foods that can help thicken output include smooth peanut butter, mashed potato, white bread and white rice (they do vary for different people but those are common thickeners). And some things that loosen output, and so may be best avoided, include alcohol, coffee, fruit juice and high fibre foods (e.g. raw fruit and veg, nuts, seeds, whole grain cereals). Watery output isn't the cause of the problem; a correctly fitted bag with the right accessories should hold watery output, but thickening it may help reduce the leakage until you can find a solution. For me the solution has always been convex bags, and working out which wipes, powder, etc. were interfering with adhesion.

Talk to the nurse, and a doctor if possible. There is a solution, it just takes some trial and error. It's nice to see how much effort you're putting into helping your client. :)

He was leaking occasionally before the surgery. But ever since the surgery he hasn't stopped leaking.

I was told he is using a convex bag.

He has a Lg scar starting mid stomach going down to his pu ic bone that is like a little ravine that's 1/2-3/4 in deep. And about 1/2 in wide. But the bag keeps leaking on the opposite side where the skin is uhber raw.

What is a wafer?

It's actually a first aid product (liquid and very sticky) that you apply with a qtip. It helps to heal the skin and keep the wafer in place.

Is the ostomy nurse coming today? Make sure you, as his care provider, are there when she is there to watch and ask her all the questions you can think of.

Like Larasmom, I swear by Compound Tincture Benzoin. Her application process is near the same as mine.

Burns like the on broken skin, but heals very quickly.

It can be purchased in the correct "formula" off Amazon or Edgepark and Medicare does pay for it.

Geritrex liquid or PDI swabs. I prefer the swabs.

Here are the pics from Amazon.

www.amazon.com/SMITHKLINE-BEECHAM-CONSUMER-Geritrex-Compound/dp/B000GCKDP4/ref=pd_sim_194_2?ie=UTF8&refRid=1K53AGXYK3C33P4FH098

www.amazon.com/Compound-Benzoin-Tincture-U-S-P-Swabsticks/dp/B002GXAZO0/ref=pd_sim_194_1?ie=UTF8&refRid=1K53AGXYK3C33P4FH098

AnnaIvy is right......the stoma nurses only know what they are shown......the last one I had, I taught her more than she taught me.......

What works for one may not work for another so don't be afraid to try new things, or as suggested, use nothing under the wafer and see if it sticks better. Less is always better when it comes to this stuff!

I've not heard of anything like that before but hope it will work! Something will.

Is it working?

Concerned
Here is my wafer change procedure.
The first time you use my procedure you may have to remove any adhesive residue. Please use alcohol.it leaves no residue. That said here is what I do.

Use no soap, adhesive removers, powder or anything else. All you need is water, paper towels and Benzoin Compound Tincture.
Remove the wafer and clean the stoma area with water and paper towel. Nothing else. Dry with a hair dryer. Apply Benzoin Compound Tincture with a Q tip. It does not hurt the stoma. Apply to the entire wafer area. Dry with a hair dryer. Apply the wafer. That's it.
The BCT is a waterproof first aid liquid. It will sting on open skin.
When you remove the wafer the BCT comes off with the wafer. There is no residue left on the skin.After I remove my wafer I shave with an electric beard trimmer.
BCT by Geriatrix is available from
drugsdepot.com
Search product. C2540383
about $4.50 plus shipping. It lasts a long time.
For paper towel I use the select a size and tear in half.
The BCT is waterproof. If you spill it only alcohol will clean it up.
As far as wafers go, I have tried others but I use Convatec convex.

Dan

I had the exact same problem. I was great for the first 3-4 weeks after my surgery. Then the leaking got progressively worse, my skin got raw, the bag stopped sticking. I went to the stoma nurse and I started using a convex wafer with a belt, and it fixed the problem.