Wound Care Made Incredibly Easy

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External threats to skin integrity

away copious secretions if they are fairly thin or liquid. Often, woven cotton gauze or foam with a slit cut in it to fit around the tube is used. In some cases, along with regular gentle cleansing and sometimes a nonalcohol liquid skin protectant, this will provide adequate protection if changed every 8 hours. With the sharp rise in tracheostomies needed due to the COVID-19 pandemic, or at any time there is an increase in respiratory illnesses, a less time intensive method may be useful.

Get wise to wounds

Chuang et al. (2013) found positive results with a pectin-based wafer sometimes used for ostomy care. This barrier could be changed every 4 days with effective results. The device may also help prevent the pressure injuries some times associated with any device that must be secured tightly enough to prevent dislodgment, such as a tracheostomy tube. Karaca and Korkmaz (2018) reported positive results using a durable barrier cream containing dimethicone and acrylate terpolymer once daily after cleansing around the tracheostomy with saline and replacing the gauze as often as necessary based on secretion amount. This cream kept the skin at a more normal acidic pH than the skin in the group using gauze alone. Maintaining the acid mantle of the skin protects it from infection and improves the barrier function.

Digestive or urinary secretions from a stoma or fistula

Just as liquid stools per rectum can be irritating to the skin, so can any digestive system effluent (output) that exits the body through a stoma or fistula, especially if the effluent is liquid. How about a quick review of expected digestive system ostomy output?

Digestive fluid source Ileostomy or ileal fistula (from the terminal portion of the small intestine)

Type of effluent

Effects on the skin

Liquid with high output, at least at first; as the body adjusts, it can become mushy or pasty.

High in digestive enzymes, which can break down skin as quickly as they do food pH is usually alkaline—around 7.5 and irritating to skin High in digestive enzymes, which can break down skin as quickly as they do food

Jejunostomy or jejunal fistula (from the middle portion of the small intestine)

Liquid with high output; usually remains liquid or mushy

Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. Colostomy or colon fistula (from the large intestine) If formed, there is less risk of related dermatitis if there is a leak from

Descending colon—usually formed stool Transverse colon—usually semiformed or pasty stool Ascending colon (less common)—usually mushy or pasty stool

ostomy pouching system. If stool is more liquid, there is a mild risk of ICD if skin is exposed often.