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Skin Barriers, new to all this

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Posted 12/2/2017 11:05 PM (GMT 0)
I have a new ileostomy (1 month old), and my ET nurse suggested the following: first layer, a holliehesive skin barrier cut to the size of the ostomy (1-1/8"). Next, an adapt barrier ring, butted up to the ostomy. Finally, the flange, cut 1 size bigger than the holliehesive skin barrier (1-1/4").

The barrier ring really swells and comes through the flange opening, and almost covers my poor little ostomy, is there a problem with this? I also have granulomas, and raw skin around the ostomy, and had an ostomy separation, so am doing whatever I can to help this matter. I'm thinking about only using either the ring or the holliehesive, any thoughts on any of this?
Posted 12/3/2017 12:50 AM (GMT 0)
BCT -Benzoin compound tincture has been my saving grace. My first ilieo I had problems like you. I'm allergic to adhesive. When someone told me about this my second time around, huge difference. My skin stayed healthy. I'm finally going to a permanent illio and ordered little vials of them so less mess and easier. But the 2oz bottles is very cheap. Hope things get better for you.

Halo
Posted 12/3/2017 6:21 PM (GMT 0)
Thanks Halo. Where do you get the BCT, and how do you apply it? Do you use q-tips? Would it be used under one of the skin barriers, or instead of the skin barriers?
Posted 12/4/2017 5:51 PM (GMT 0)
Use the new Brava Protective seal / rings they don't swell much at all. I use the 4.2 mil thick. Then pick a seal closest to your stoma size. For example I order the 18 and I stretch it to fit my 22 stoma. Make sure its NOT the Brava moldeable ring those suck. Your hole must be cut way too big if it swells to the point of covering your stoma . I also put on a Safe and Simple skin barrier then Brava ring on top. My skin looks great no problems . Try theses.

Post Edited (Sugarmarie) : 12/4/2017 10:57:59 AM (GMT-7)

Posted 12/4/2017 9:09 PM (GMT 0)
Thank you, Sugarmarie. I just went on-line and will be ordering a sample of the ring you suggested. And you're right, I think my hole's been cut too big.

With my appliance change yesterday, I skipped the adapt ring, and am just using a Holliehesive skin barrier beneath my Hollister New Image wafer (convex). The burning that was there yesterday is much improved today. When my skin is finally healed, I believe I can skip the holliehesive and just use a ring. Hopefully the Brava protective seal will work for me, too. Thanks for your advice. I need all the help I can get! (My ET nurses are all about 2-1/2 hr. away, I'm on a mission to find a local one, that should help matters, as well).

I forgot to mention, my stoma is quite irregular, especially now that it has several granulomas along the base here and there. Makes cutting the hole SO difficult. Probably why I cut it a little big, to work around the granulomas. Seems either I need to cut a little big to avoid irritating the granulomas, and risk leakage onto the skin, creating damaged skin, or cut it close enough to avoid sore skin, and irritate the granulomas! What to do, what to do.....

Post Edited (dinkley) : 12/4/2017 2:12:46 PM (GMT-7)

Posted 12/5/2017 5:56 AM (GMT 0)
Dinkley ,
If you use Convex wafer order the thin ring not the 4.2 can't remember the thickness but there are only 2 available so not 4.2 thick get thin one .
Use this trick . Instead of trying to eyeball and stretch the ring hole to fit your stoma break it open in one spot so you have a U shape . Use fingers to soften ring a little to stretch where you think it's a big enough U SHAPE to go around your stoma . Start by tucking U shape on lower/ underneath part of stoma . Snug up against it . Then work your way around your stoma till both ends meet and press ends into each other . That way you can custom fit the ring around your stoma .
Use the clear plastic removable sheet on back of wafer to cut a templet for your irregular stoma . Once you have a good shape transfer that shape to wafer then cut it .
Use a barrier sheet First that way your skin it protected from any output . I love the Safe and Simple brand . It's super thin . On that one transfer stoma shape it has to be cut too. But very worth it . The barrier sheets protect skin from adhiesives from the wafer tape that can cause itching . I use the New Image line also and love it .

Post Edited (Sugarmarie) : 12/4/2017 11:01:07 PM (GMT-7)

Posted 12/5/2017 6:14 AM (GMT 0)
Dinkley ,
I found this info .

Granulomas are a type of skin problem that can develop around a stoma. In many cases, these raised, red bumps develop because the ostomy bag is not properly fitted or because the stoma is not raised high enough above the level of the skin. In both situations, waste from the stoma may leak onto the skin, causing irritation, leading to granulomas. An infection can also cause granuloma formation, or they can result from the bag repeatedly rubbing against the skin. In some cases, problems with the skin's healing process after ostomy surgery also can lead to granulomas.

The most effective treatment for granulomas is the topical application of silver nitrate, which creates a mild chemical burn, destroying the granuloma. Applied once or twice a week, when the ostomy bag is changed, this medication can often eliminate or shrink the granulomas. Also, to prevent granulomas from getting worse, it's important that the fit of the ostomy bag be checked to make sure that it's not allowing any leaks. As you mentioned, freezing the tissue affected by granulomas -- a procedure known as cryotherapy, or destroying the tissue with heat -- called cauterization -- can also be treatment options.
Hope you heal soon , SM
Posted 12/8/2017 3:03 PM (GMT 0)
Thanks for the information, SM: I saw a local ET nurse yesterday, and she made several suggestions.

First, she looked at the wafer that we removed (it had only been on for 1 day), and the wax ring had deteriorated already. She thinks I "run hot" in my stomach area, and that can cause wafers to deteriorate quicker. I don't really know what to think/do about that, anybody hear anything like it?

She did apply silver nitrate to 2 small granulomas. What I thought were the other larger granulomas running around the base of the stoma are just the areas where the stitches are, to my understanding.

Then, she first massaged in a teeny tiny bit of sween cream on the skin around the stoma and outward. Then we used stomahesive powder, and she also used no-sting protective skin barrier wipes on the skin around the stoma and outward. Finally, instead of the holliehesive skin barrier + wax ring, she suggested just the wax ring with ceramide. The ring was placed directly on the wafer rather than on the ostomy, and then applied ... if I'm getting all my terminology correct here!

So, the good news is, this will make things a little simpler for me - 1 cut only. And the ring is not "turtlenecking" so crazy as it did when I put it on the stoma directly.

I asked her about the tincture of benzoin, and it was her feeling that it can be irritating to the skin. I still may try it down the road, since I ordered a small bottle of it already ...

So I'm starting to feel a little bit better about all this, and I want to thank you guys for your input, so very helpful!
Posted 12/9/2017 11:46 PM (GMT 0)
Dinkley,

Sorry took so long to get back. Had Emma created this week. You can find it anywhere online. I used a qtip to apply. I just use that then my bag. But you have other issues that you got great advice on here. I have learned a lot on here. More than any dr or stoma nurse has.

Hope things work out for you.

Halo
Posted 12/10/2017 1:12 AM (GMT 0)
Dinkley,
I have never heard of the running hot theory. Usually that would help things to stick .
Once you get the Brava Protective seal/ rings I think you will see a big difference in the " melting " factor . These don't melt come right of skibpn easy . Try using a spray adhesive remover the less rubbing the skin the better . I use the Brava spray adhesive remover . Just spray a corner to start lift that coner then start pulse spraying as it releases wafer spray a little more release wafer and keep going till it's all off . It works very fast comes off instantly.
I agree with Halo I learned more from other Ostomy people than from a nurse . You have to live with it to really know .
Feel better SM

Post Edited (Sugarmarie) : 12/9/2017 6:20:06 PM (GMT-7)

Posted 12/12/2017 8:58 AM (GMT 0)
Hi, So my ostomy nurse showed me many years ago how to keep the barrier ring from turtlenecking around the stoma. I cut the water to the exact size of the stoma with no gap then I stretch the barrier ring so it is slightly larger. Then I apply that to the barrier keeping it just a little bit from the edge so that you give it room to swell. Once it swells it too will be even with the stoma. She said it also supports the barrier ring to do it that way, otherwise if you let it turtleneck there is no support behind it and it has the tendency to start peeling up and letting stuff get under. I have been doing it this way for well over 10 years and I get six days wear time. Some people actually like that turtleneck effect but it never worked for me. Just have to keep experimenting til you find what’s good for you. 🙂
Posted 1/26/2018 6:35 AM (GMT 0)
Hi
Not sure if anyone else does this, but I only use 1/2 of the barrier ring and mold it back into a circle. I also put it on the flange itself, around the cut out, instead of on my skin. If I have time I hit it with a couple of seconds of hot air from a blow dryer before putting it on. Seems to work for me.
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