Post-ostomy case sharing.

Introduction: Colostomy skin and mucous membrane separation is a common complication after enterostomy. Colostomy skin and mucous membrane separation refer to the separation of the intestinal mucosa and abdominal wall skin at the suture of the colostomy, which is an early complication after enterostomy surgery. One of the symptoms usually occurs 1 to 3 weeks after the operation. Ostomy care is very important for patients with stoma skin and mucous membrane separation, and wound treatment is equally important. Silver ion dressings and alginate dressings have strong sterilization and exudate absorption effects on wounds; the combined application of the two to the wound can accelerate the healing of the skin and mucous membrane separation wound of the enterostomy and relieve the pain of the patient's wound. The nursing effect is now reported as follows :

What can cause mucocutaneous colostomy separation?

Ischemic necrosis of the stoma, excessive stoma tension due to large skin opening during stoma formation, too few surgical sutures, patient sensitivity or poor absorption of sutures, secondary infection, malnutrition, diabetes, long-term steroid use, Drug-induced poor tissue healing, preoperative radiotherapy, etc.

Let's look at a set of clinical cases:

The patient, a male, 30 years old, had temporary stoma surgery for Crohn's disease. The normal weight was 110 catties, and the postoperative weight was 85 catties. The ostomy bag was replaced by the nurses within two weeks after the operation. During the period, the doctors and nurses did not observe the stoma, which resulted in the separation, ulceration, and severe infection of the stoma mucosa and skin. The patient suffered unbearable and unbearable pain. When the patient Xiao Dong found our stoma teacher, Nurse Sun, the infection of the stoma was already very serious, and it was very difficult to take care of it. The replacement of the hospital nurse did not improve. After discharge, his wife helped to replace it. This medical accident was caused by the negligence of the medical staff; Before March 7, the patient had a sinus tract 5-6 cm deep in one place of the stoma. At the same time, there is a small hole on the edge of the stoma mucosa, and there is gas. This kind of wound is the first step to debride the wound. The patient has been discharged from the hospital and can only take care of the stoma by himself or his family. Nurse Sun asked him to wash the wound with normal saline first. And then soaked in iodophor disinfectant for 10-20 minutes, and then cleaned the disinfectant with normal saline. After drying the wound, it is filled with a silver ion dressing and covered with an ultra-thin hydrocolloid dressing. Finally, use a leak-proof cream and an ostomy bag according to the usual stoma care method. Every two days, it takes nearly 2 hours for his wife to change it for him. Nutrition is poor at this time.

Ask about the wound on March 14 :

The patient complained of a lot of pus during dressing changes every day and no odor. The wound did not expand or deepen. Change the medicine once a day for the past week. (The pus should be filled with a hydrophilic dressing, which becomes a gel after absorbing water. This dressing contains silver ions, which can sterilize and reduce inflammation)

Ask about the wound on March 15 :

The patient reported that the wound was 1mm smaller, and the air out of the small hole was not obvious before the observation. No other exceptions occurred. The curling condition continued; the color was pink, the ostomy bag did not leak, and the visual infection did not increase. On the premise of protecting the wound, it is recommended to change the dressing once every two days, rinse the wound with normal saline, continue to soak and debride the wound with iodophor disinfectant, fill each place with silver ion dressing, and try not to leave dead space. Due to repeated low-grade fever, the patient went to the hospital again, where he repeated low-grade fever for two months, and finally got rid of the fever after taking Leke. He was discharged from the hospital on April 20. The patient was discharged from the hospital after the fever subsided. After that, the wound healed relatively quickly, the granulation quickly crawled, the sinus tract recovered, and the fistula was not obvious. Continue filling care with silver ions, oil gauze, etc. Suggestions in life: eat small meals often, eat digested food, move around properly, and prevent colds. The patient did not slowly gain weight until mid-May. In July, it increased from 85 pounds to 100 pounds. He ate Ansu and high-protein food four meals a day, pork ribs soup, fish, and shrimp every day. It is usually eaten with fatty meat, tube bone soup, etc. She underwent stoma retraction surgery in September and is recovering well.

Of the stoma wound to prevent wound infection. Once the damage becomes infected, please go to the hospital for professional care in time.

Which dressing should be chosen for a patient with mucosal stoma separation?

Such patients are advised to consult with a professional ostomy specialist and then choose the following dressings for care:

Longterm Medical Alginate Dressing: The alginate dressing ingredient is made from a natural material derived from seaweed and is a highly absorbent and biodegradable dressing. Alginate dressing is a multi-purpose dressing. According to the specifications, it is mainly divided into sheets and strips. The sheets are mainly used for the treatment of superficial wounds, while the strips can be used for cavity wounds, sneaks, and sinus tracts. The high absorption capacity of therapeutic alginate dressings is due to the exchange of sodium ions (Na2+) in the exudate with calcium ions in the dressing, resulting in the formation of a sodium alginate gel. The gel can adapt to the wound surface, and deliver growth factors and pro-healing cells to facilitate wound healing.

Longterm Medical Hydrocolloid dressing: Hydrocolloid dressing provides the wound with a slightly acidic and moist environment suitable for wound healing, has a waterproof effect, is suitable for superficial wounds, absorbs a small amount of exudate, and promotes epithelial crawling.

Longterm Medical Silver lon dressing: The advantages of silver ion antibacterial dressing are that it can shorten the healing time of the patient's wound, reduce the time for the patient to change the dressing, and has strong sterilization ability.

The correct nursing operation process for separation of enterostomy mucosa and skin :

Physiological saline cleaning of wounds - Iodophor disinfection - Physiological saline cleaning again, dry - dressing filling (gel, alginate dressing, preferably silver ion dressing) - waterproof dressing covering (film or hydrocolloid) dressing) - leak-proof cream - ostomy bag.

Health Education | Caring for Patients

Health education has become one of the means to prevent ostomy complications, which can better improve the quality of life of patients and reduce additional medical expenses. The effect of ostomy surgery is also closely related to the health education of nursing staff. Health education should be given to people who have just finished ostomy. Giving care and patient guidance can greatly improve the quality of life and satisfaction of patients.

Longterm Medical is a leading company in the industry, with advanced and complete production equipment and inspection systems, as well as a complete set of scientific and sound management systems. At Longterm Medical, we transform this data by innovating and developing products that make life easier for people with caring needs.

For more information on Innomed® dressings, refer to the previous articles. If you have customized needs, you are welcome to contact us; we will serve you wholeheartedly.

At Longterm Medical, we transform this data by innovating and developing products that make life easier for those who need loving care.

Editor: kiki Jia

Date: July 22, 2022