1. Exploring the Intricacies of Stoma Care
Date: 25 June 2018 Presented by: Bernadette Ambrose
Stoma Care Nurse Specialist
West Suffolk Community

2. Introduction Some common reasons for stoma formation
Overview of the 3 types of stomas
The importance of Skin Health
‘p’ Ratings in West Suffolk
Accessory usage

3. Some common reasons for Stoma formation
Carcinoma (bowel & bladder)
Diverticulitis
Inflammatory Bowel Disease
Familial Polyposis
Trauma
Neurological damage (M.S.)
Incontinence
Congenital Disorders

4. Colostomy
A colostomy is formed from the large bowel Can be permanent or temporary Can be a loop or an end stoma Output is usually formed or soft faeces Generally use a closed bag Pouch change depends on bowel function can be 2-3 times a day

6. Loop Colostomy

7. Ileostomy Formed from the ileum Generally on the R side
May be temporary or permanent
Loop or end, should be spouted (2.5cm)
Output – loose, porridge like consistency
Use a drainable bag
Empty 4-6 x day and change alternate days

9. Urostomy
Formed form a section of bowel used to form a conduit into which ureters are attached.
Always permanent, end stoma
Urine will always contains some mucus
Pouch with a tap or a bung
Emptied 5-6 times a day
Bag changed alternate days

11. The ‘Perfect’ Stoma
Until the advent of the Brookes ileostomy, there was no gold standard for the formation of a spouted ileostomy & ileal conduit.1
St Marks’ Hospital London UK published a paper written by Celia Myers and Robin Phillips to set the new standard for a slightly spouted colostomy.2
History of Ostomy Surgery – D. Doughty. Journal of Wound, Ostomy, & Continence Nursing Vol. 35, No
2. Minimally Raised End Colostomy – B.M. Stephenson., C. Myers, R.K.S. Phillips. International Journal of Colorectal Disease Vol. 10. No
In the mid 1950s Surgeon Bryan Brooke pioneered the protruding stoma which significantly improved clinical outcomes for ileostomy patients. Then in 1995 Myers and Phillips developed a slightly raised colostomy which enabled the patient to see better and improving management.

12. Perfect Ileostomy/Urostomy
The perfect ileostomy/urostomy should have a 2-3 cm spout in order to avoid leakage

13. However……
Not everybody is perfect!!! And sometimes surgeons are limited with their siting options. We have an increasing obesity epidemic and with the aging process the skin and muscle tone of the abdomen lessen.

14. The Skin Largest organ Divided into 2 Layers Functions
Epidermis
Dermis
Functions
Thermoregulation
Protection
Waterproofing
Synthesis of Vit D
sensation
Differs in appearance & Structure
Location
Age
Disease
nnThe skin forms the largest organ of the body, it has the ability to regenerate and, in the healthy individual, to repair damage which has been inflicted upon it.
The skin itself is composed of two layers, the outer epidermis, which consists of cells that migrate from the basal layer to the surface. The epidermis is avascular and varies in thickness depending on location. It is composed of 5 layers, the uppermost layer is called the stratum corneum.
The dermis is a thicker layer that contain sweat glands,blood vessels, nerve endings and hair follicles.
The main functions of the skin include thermoregulation, protection, waterproofing, synthesis of vitamin D and the transmission of sensation.
Skin differs in appearance and structure depending on location on the body, age, and in the presence of disease. 14

15. Consequences of a NOT so perfect stoma

17. The Problematic Stoma
Many people with a stoma may experience complications at some point.
Many factors contribute to a problematic stoma
In 2008 we initiated the ‘P’ Rating system where each stoma formed at the WSH was given a rating depending on the number of accessories required to ensure a secure fit.
The purpose of this was to initiate discussion and help improve the quality of the stomas formed, thereby improving the patients quality of life and reducing the cost in accessory usage.
Type of stoma, Height of stoma, emergency or elective, BMI, gender, diagnosis

18. ‘P’ RATINGS - A STOMA GRADING TOOL
Number of
Accessories
Required
Accessory Type p0
N/A p1 1
Convex p2 2
Convex, belt p3 3
Convex, belt, paste p4 4
Convex, belt, paste, seals p5 5
Convex, belt, paste, seals & extenders

19. ‘p’ Ratings Overview of p0 – p1 Stomas
2008
2010
2012
2015
2016
2017
78%
82%
72%
77%
92%
98%
In % of all stomas formed at the WSH did
not require any accessories to achieve the perfect
Fit.

20. The Importance of a Good Fit

21. Conclusion
My role as a Stoma Care nurse explores the intricacies of Stoma Care on a daily basis.
Skin Health is paramount to ensure the patient continues to have the confidence and ability to lead an active and full life following this life changing surgery.