Efron20 advocates the use of a convex stoma appliance in order to achieve a good seal in the patient with stomal retraction. Convex appliances curve outward toward the skin to help the retracted or flush stoma protrude into the pouch. They can flatten and smooth out peristomal creases and abdominal contours. Convexity is available in varying levels, and the shallowest degree that achieves secure pouching should be used. Skin barrier rings or strips can be added to the barrier to increase convexity. Since convex appliances are less flexible and may leave an imprint on the abdomen, frequent monitoring for signs of sustained excessive pressure that could lead to an ulcer is warranted.21 The WOC nurse should observe the patient for resolution of an erythematous imprint during pouch change and peristomal skin care. Precautions for the use of convexity also include mucocutaneous separation, ulcerations, peristomal hernias, and varices.20
An ostomy belt may be used to enhance the stability of an appliance on a soft abdomen or to hold the pouching system in place for a tighter seal. The belt should be worn parallel to the stoma rather than at waist level. It should be fitted so that it is snug but not too tight. Precautions include monitoring for dermatitis, epidermal denudement, ulceration, and damage of peristomal varices. The use of a custom silicone or rigid faceplate may also be considered.17 The patient should be counseled to avoid excessive weight gain that can place tension on the stoma and cause retraction. Surgical modification may be required if the patient is unable to achieve adequate, secure pouching using convexity or stomal belts.
Efron20 advocates the use of a convex stoma appliance in order to achieve a good seal in the patient with stomal retraction. Convex appliances curve outward toward the skin to help the retracted or flush stoma protrude into the pouch. They can flatten and smooth out peristomal creases and abdominal contours. Convexity is available in varying levels, and the shallowest degree that achieves secure pouching should be used. Skin barrier rings or strips can be added to the barrier to increase convexity. Since convex appliances are less flexible and may leave an imprint on the abdomen, frequent monitoring for signs of sustained excessive pressure that could lead to an ulcer is warranted.21 The WOC nurse should observe the patient for resolution of an erythematous imprint during pouch change and peristomal skin care. Precautions for the use of convexity also include mucocutaneous separation, ulcerations, peristomal hernias, and varices.20 An ostomy belt may be used to enhance the stability of an appliance on a soft abdomen or to hold the pouching system in place for a tighter seal. The belt should be worn parallel to the stoma rather than at waist level. It should be fitted so that it is snug but not too tight. Precautions include monitoring for dermatitis, epidermal denudement, ulceration, and damage of peristomal varices. The use of a custom silicone or rigid faceplate may also be considered.17 The patient should be counseled to avoid excessive weight gain that can place tension on the stoma and cause retraction. Surgical modification may be required if the patient is unable to achieve adequate, secure pouching using convexity or stomal belts.
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