Ileostomy/Colostomy/Broviac/ PICC Line
Somethings are standard in ostomy care that will always help with adherence. Here are a few:
Do not use any soap that contains oils - the oil will prevent the wafer from adhering properly.
Prior to applying your child's bag, warm up the wafer under your shirt (armpit will work just fine). This will help it adhere to the skin and make it more flexible.
Never use fabric softener on the wash-cloths because it will make the bag peel right off.
You can use a rice filled cloth bag and prewarm it in a microwave. After applying the ostomy bag to baby, put the warm bag of rice on top of it for about ten minutes. This helps the wafer adhere and form to baby's body. Of course, be sure that the rice filled bag isn't too hot.
Determine where the leak is coming from.
Sometimes the stoma develops "holes" which allow for the output to come out from areas other than the center of it, where it's supposed to. In these cases:
1. Clean the skin with warm water and dry completely.
2. Using stomahesive paste, surround the stoma, being careful to get underneath and around completely. It's like caulking a faucet!
3. Cut the hole on the wafer so that it's larger than the base of the stoma. In this case, you don't want a snug fit around the stoma because you'll end up with output leaking all over again.
4. Use a belt to secure the system.
*Sometimes when a bag leaks and the output has been sitting on the skin a while, the skin will breakdown, leaving small lesions. We never use adhesive removers that aren't the "no sting" type. The regular ones contain alcohol and it STINGS when used on broken skin.
*Use "no sting" adhesive remover when removing a bag
*I've found that the skin prep that's "no sting" is completely worthless. In fact, it seems to make the bag peel off, just the opposite of what you want.
*The regular skin prep stings if there are any small lesions on the skin! We just skip the skin preps altogether now, but have used them in the past. There doesn't seem to be much of a difference as far as the bag staying on better whether we use one or not.
*Make sure you don't let the bag become overly full. This is a sure way to spring a leak.
*It's not uncommon to need to try several different types of bags before finding one that works for your child. Ask for samples!
*Belts are often the solution to leaking issues. Belts attach to loops on the sides of wafers, which provide extra support and will actually hold the wafer in place. Several parents have reported to me that the belt "saved" them.
*We have used stomahesive paste and barrier rings. Both have their ups and downs. What has worked best for us, to avoid leaks, is to use both. We first put the stomahesive paste into a 5cc syringe (remove the needle!) and then squirt it around the stoma, making sure you get it into all the little cracks. Then we use the barrier ring on top of it. If you take the barrier ring and break it, then wrap it around the stoma, remove the excess pieces, you'll have a snug fit, which is what you want. Think of the stomahesive paste and barrier ring as caulking!
*If your child's output is excessively loose or watery, consider using a urostomy bag, which is designed for urine. This is what we use.
*Avoid yeast while on antibiotics! After you clean your child's skin, sprinkle Mitronazole (Rx only) on and dust it around ...then blow the remaining amount off. If you do this, you'll need to use a skin prep wipe because the bag will not adhere to powdered skin. If your child's on antibiotics, I would do this as a preventative measure, even though the skin preps that actually work can sting if there are small lesions. Hopefully, there won't be, but if there are, you can use a non-sting wipe first, let it dry and then use the regular skin prep pad. This will create a barrier, so it won't be so painful when you apply the second layer of regular skin prep. If your child ends-up with redness, bumps or lesions, it could be candida and that's a nasty fungus to deal with. Your child will most likely have small lesions if there's a yeast infection and then you have you use the powder and the skin prep wipes. Candida is nasty. Avoid it!
**Cut the opening of the bag so that it's just a bit smaller than the base of the stoma. You want it to be as snug as possible, without compromising circulation.
*These are tricky because they "clot off" quickly and aren't meant to last long. Typically, PICC lines are expected to last no more than four months (max!), however, with proper care and luck, PICCs can last a very long time. Tyler had the same one for over a year before it dislodged and ultimately fell out. The one he had before that last about eight months, so we know that they can function for a long time. I originally chose a PICC line for Tyler instead of a Broviac because Tyler had two incidents of systemic yeast and when there's yeast in the blood, all lines must be removed (tricky yeast is slimy and sticks to the lumen of the catheter, making it impossible to clear the infection completely) And when using Broviacs, there are only so many access sites that can be used before running out of places to put it. Tyler was still so little and I knew that we had years of TPN ahead of us, so I opted for the PICC.
*If your baby is small enough, I found that the best way to keep it dry during bathing is to put a non-sterile glove on the arm and use lots of Microfoam tape to secure it. I did this several times without the dressing becoming wet at all.