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Journal of Wound, Ostomy & Continence Nursing:
doi: 10.1097/WON.0b013e31825dd6a4
Ostomy Care Literature Review

Ostomy Care Literature Review 2011

Mueller, Susan BSN, RN, CWOCN; Contributor; Reimanis, Cathryn MS, RN, ND, CNS, ANP-BC, CWOCN; Contributor

Section Editor(s): Fellows, Jane A.

Free Access
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General Concepts in Ostomy Care

O1. Fecal Ostomies: Practical Management for the Home Health Clinician

Jones T, Springfield T, Brudwick M, Ladd A. Home Health Nurse. 2011;29(5):306–317.

Article Type: Integrative Review

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Description/Results:

* A complete guide for education of the home care clinicians providing ostomy care.

* A comprehensive review of the literature and excellent review of basic care of fecal ostomies including OASIS-C documentation.

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What does this mean for me and my practice?

This is a useful tool for the clinician doing staff education or for those needing a review of current practice.

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O2. Characteristics of the Patient With an Ostomy

Pittman J. Journal of Wound, Ostomy and Continence Nursing. 2011;38(3):271–279.

Article Type: Research Study

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Description/Results:

* A descriptive cross-sectional study with 144 subjects with new ostomies looking at clinical characteristics of the population and disposition at discharge.

* Patients with advanced age (P = .047), stoma height at or below skin surface (P = .002), and emergent surgery (P = .005) were more likely to be discharged to an extended care facility rather than home.

* Discussion about stoma site marking and potential effect on complications is also included.

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What does this mean for me and my practice?

By examining the demographic and clinical characteristics of our patient populations, we may be able to develop programs and interventions to decrease the occurrence of complications.

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O3. Ileal Pouch Anal Anastomosis: An Overview of Surgery, Recovery, and Achieving Postsurgical Continence

Psillos A, Cantanzaro J. Ostomy Wound Management. 2011;57(12):22–28.

Article Type: Integrative Review

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Description/Results:

* This article provides an overview on the indications for Ileal Pouch Anal Anastomosis (IPAA) surgery and postoperative changes.

* A brief summary of quality-of-life pre- and postoperative IPAA revealed an overall improvement in pain and fecal urgency in those with severe ulcerative colitis. Overall, improvements in health-related quality-of-life indicators were positive for those with a functioning pouch compared to those who had pouch failure.

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What does this mean for me and my practice?

This article provides practical information for the ostomy nurse who provides perioperative education and management to the IPAA patient. Opportunities for the ostomy nurse include patient education related to perineal skin care and bowel function management with diet and medications; fecal continence retraining techniques and pouch complication management are also provided.

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O4. Orthotopic Neobladder Irrigation: Competency Assessment Through Simulation

Zamora Z, Clark MJ, Winslow B, Schatzschneidder M, Burkhard J. Urologic Nursing. 2011;31(2):113–120.

Article Type: Quality Improvement Report

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Description/Results:

* Provides a thorough discussion of the need for neobladder irrigation and documentation of the procedure, knowledge deficit of the nurses, and use of simulation for teaching.

* After a 1-hour simulation, nurses reported improved satisfaction, appropriate documentation rose by over 60%, and the need for physician intervention in irrigation decreased by more than 40%.

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What does this mean for me and my practice?

Results suggest that simulation is an effective method of nursing staff education.

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O5. Nutritional Care of the Ostomy Patient

Collins N, Sulewski C. Ostomy Wound Management. 2011;57(1):10–12.

Article Type: Integrative Review

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Description/Results:

* A concise review of the effect of ostomy surgery on nutrition and important teaching points for patients.

* Emphasizes the importance of discouraging patients from fasting or decreasing food intake as this will cause more bloating and gas than small frequent meals.

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What does this mean for me and my practice?

Nutrition education is an important part of postoperative education and this article provides some charts about foods that may be helpful to include.

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O6. Relating Knowledge of Anatomy and Physiology to Peristomal Skin Care

Rolstad BS, Ermer-Seltun J, Bryant R. Gastrointestinal Nursing. 2011;9(9):3–9.

Article Type: Integrative Review

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Description/Results:

* In-depth review of anatomy and physiology of skin and the relevance to selection of a skin barrier for ostomy patients.

* Appropriate skin barrier selection will reduce risk of peristomal skin complications and the added cost of treatment.

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What does this mean for me and my practice?

By enhancing the knowledge of the anatomy and physiology of the skin and ostomy barrier physical/chemical properties, WOC nurses have an opportunity to provide evidence-based and patient-centered ostomy care.

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O7. Adenocarcinoma of a Colostomy Following Abdominoperineal Resection for Squamous Cell Carcinoma of the Anal Canal: A Case Study

Wild J, Ganer J, Skinner P. Ostomy Wound Management. 2011;57(5):38–40.

Article Type: Case Study

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Description/Results:

* This study informs the reader of a rare recurrent neoplasm surfacing on a colostomy 3 years postabdominoperineal resection. The specifics of stomal malignancy and second cancer incidence of anogenital squamous cell carcinomas are reviewed.

* The importance of stoma assessment for any bleeding, growths, or ulcerations with prompt reporting to a health care clinician is reinforced.

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What does this mean for me and my practice?

Given the rare incidence of resected anal squamous cell carcinoma followed by de novo colon adenocarcinoma, patient education of stomal complications remains an integral aspect of ostomy education. Early identification and timely referral of significant stomal complications to the colorectal surgeon must be an active treatment option for the ostomy nurse.

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Stomal and Peristomal Skin Complications

O8. The Development and Use of Algorithms for Diagnosing and Choosing Treatment of Ostomy Complications: Results of a Prospective Evaluation

Kalashinikova I, Achkasov S, Fadeeva S, Vorobiev G. Ostomy Wound Management. 2011;57(1):20–27.

Article Type: Research Study

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Description/Results:

* The purpose of this study was to evaluate the usefulness of an algorithm using clinical presentation and pictograms for assessing, diagnosing, and managing ostomy complications by trained nonspecialty nurses. The complications were divided into stomal and peristomal skin disorders with initial diagnoses made by nurses and confirmed by physicians.

* A total of 1427 Russian ostomates were assessed over a 2-year period; 38.8% presented with at least 1 ostomy-related complication, and 34.9% had 2 or more. Stoma-related and peristomal skin complications were 69.9% and 64.2%, respectively.

* Stoma complications included parastomal hernia (25.1%), mucocutaneous separation (18.6%), prolapse (16.8%), retraction (14.2%), stenosis (7.8%), mucosal hypergranulation (7.8%), and fistula (4.9%).

* Peristomal skin disorders included contact dermatitis (89.3%), hypergranulation (6.8%), allergic dermatitis (2.0%), and folliculitis, psoriasis, and herpes (1.9%).

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What does this mean for me and my practice?

This article provides a structured approach for assessing and managing ostomy-related complications. It enables the ostomy nurse to identify when conservative, nursing-managed treatment is appropriate and if a surgical referral is needed for additional diagnostic testing and management. It reinforces the specialty practice and unique knowledge base of the ostomy nurse in preventing and conservatively managing stoma and peristomal skin disorders. Statistical testing is needed to validate the algorithm.

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O9. Using Chamomile Solution or a 1% Topical Hydrocortisone Ointment in the Management of Peristomal Skin Lesions in Colostomy Patients: Results of a Controlled Clinical Study

Charousaei F, Dabirian A, Mojab F. Ostomy Wound Management. 2011;57(5):28–36.

Article Type: Research Study

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Description/Results:

* The purpose of this study was to compare the effect of daily topical steroid use to twice-daily German chamomile compress applications (active ingredient chamazulene) on peristomal skin lesions in colostomates. The primary outcome variable was time to healing (days); itching and pain data were also collected.

* Two groups of 36 patients were assigned to treatment arms based on matching variables (body mass index, age, barrier wear time, peristomal skin history, to name a few). Peristomal skin was assessed every 3 days with a maximum duration of 28 days.

* Statistical testing to assess reliability of the peristomal skin assessment instrument as well as interrater reliability was acceptable.

* The results demonstrated that the chamomile-treated lesions healed faster than the comparison group (mean, 8.89 days vs 14.53 days, P = .001). Complete healing time for 100% of the chamomile group occurred at day 15 compared to 76% of the hydrocortisone arm at day 21.

* Itching and pain were relieved in both groups; no statistical differences were presented.

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What does this mean for me and my practice?

This article provides additional evidence supporting the inclusion of herbal medications, specifically standardized chamomile extract, to the armamentarium of managing peristomal skin lesions. The personal and financial burden of increased appliance changes must be factored into the twice-daily compress treatments.

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O10. Untreated Peristomal Skin Complications Among Long-term Colorectal Cancer Survivors With Ostomies

McMullen CK, Wasserman J, Altschuler A, Grant L, Hornbrook MC, Liljestrand P, Briggs C, Krouse RS. Clinical Journal of Oncology Nursing. 2011;15(6):644–650.

Article Type: Research Study

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Description/Results:

* Qualitative study of 31 cancer survivors with permanent ostomies and their family caregivers.

* Survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications.

* Survivors with spouses who collaborated in their ostomy care reported that having assistance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines.

* Those providing care on their own reported more difficulty with solving problems and seeking help.

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What does this mean for me and my practice?

Asking to see the peristomal skin in those with ostomies may lead to identification of problems not verbally reported especially with those who have no assistance from unpaid caregivers.

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O11. Evaluation of a Cyanoacrylate Dressing to Manage Peristomal Skin Alterations Under Ostomy Skin Barrier Wafers

Milne C, Saucier D, Trevelini C, Smith J. Journal of Wound, Ostomy and Continence Nursing. 2011;38(6):676–679.

Article Type: Case Study/Case Series

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Description/Results:

* Topical cyanoacrylate was used for the management of peristomal skin alteration in 6 acute care and 5 outpatients.

* Improved wafer adherence, skin healing, and markedly decreased pain led to high satisfaction with the product.

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What does this mean for me and my practice?

Topical cyanoacrylate may be considered when treating peristomal skin alterations although the directions for use should be followed carefully and appropriate patient selection is important, as it is costly.

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Quality of Life Following Ostomy Surgery

O12. Prospective Study of the Impact on Quality of Life of Cystectomy With Ileal Conduit Urinary Diversion for Neurogenic Bladder Dysfunction

Julien Guillotreau J, Castel-Lacana El, Roumiguie M, Bordier B, Doumerc N, De Boissezon X, et al. Neurourology and Urodynamics. 2011;30:1503–1506.

Article Type: Research Study

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Description/Results:

* A prospective study of 48 subjects (38 with multiple sclerosis, 7 with spinal cord injury, 3 other neurologic disease) who had a cystectomy and ileal conduit for complications arising from neurogenic bladder dysfunction.

* QOL was measured pre- and 6 months postoperatively using 2 self-administered questionnaires (Qualiveen and SF36-v21).

* Surgery improved the urinary QOL (P = .015) of patients with neurogenic bladder dysfunction by decreasing limitations (P ≤ .001) and constraints (P = .046) induced by urinary disorders. There was no positive impact on general QOL, but also no negative impact.

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What does this mean for me and my practice?

Persons with significant negative impact on their work and social lives from neurogenic bladder dysfunction may benefit from referral for surgical consideration.

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O13. Social Connectivity in Those 24 Months or Less Postsurgery

Nichols T. Journal of Wound, Ostomy and Continence Nursing. 2011;38(1):63–68.

Article Type: Research Study

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Description/Results:

* Data were extracted from the Ostomy Health and Life Assessment (Hollister, Inc), a cross-sectional survey, and 560 subjects in North America and the United Kingdom were included in the study. Subjects were divided into 2 groups, those describing themselves as socially isolated and those describing themselves as socially connected.

* The socially isolated group reported poor adjustment to a stoma, disability due to the stoma, and a significantly lower life satisfaction score when compared with the socially connected group.

* Social connectivity increased in both groups as time from surgery increased and the WOC nurse relationship played a subtle but statistically significant role in helping to reestablish social connectivity, an improved body image, and acceptable life satisfaction after surgery.

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What does this mean for me and my practice?

Consideration of a patient's social resources and helping patients to seek and accept support during the pre- and postoperative period may improve their adjustment to an ostomy.

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Culturally Sensitive Care

O14. Understanding Religious Beliefs of Patients Needing a Stoma

Black P. Gastrointestinal Nursing. 2011;9(10):17–22.

Article Type: Integrative Review

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Description/Results:

* Provides a comprehensive look at the religious life of a Muslim patient and the profound effect that an ostomy has on the ability to participate in cleansing rituals prior to prayers, fasting, and participating in the religious community.

* Even if an ostomy is required with bowel surgery or if it is temporary, increased flatus or frequency of bowel movements makes religious and social activities more difficult.

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What does this mean for me and my practice?

It is imperative that WOC nurses are able to help patients understand the effect that their surgery will have on bowel function in the short and long terms during the preoperative period.

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O15. Culture and Psychosocial Function in British and Japanese People With an Ostomy

Simmons K, Maekawa A, Smith J. Journal of Wound, Ostomy and Continence Nursing. 2011;38(4):421–427.

Article Type: Research Study

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Description/Results:

* The Ostomy Adjustment Inventory–23 (OAI-23) was completed by 948 subjects (464 British and 484 Japanese) with a fecal or urinary stoma, and the results were compared to see if the country of residence made a difference in adjustment to an ostomy.

* Both groups showed improved adjustment to an ostomy as the time with an ostomy increased, but the overall adjustment scores were significantly higher in the British subjects, suggesting that cultural beliefs and response to illness between the 2 groups affect adjustment to an ostomy.

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What does this mean for me and my practice?

It is important for WOC nurses to be culturally sensitive by identifying those persons whose ostomy adjustment problems may be culturally related and finding ways of providing support.

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Fistula Management

O16. Management of Enterocutaneous Fistulas

Schecter W. Surgical Clinics of North America. 2011;91:481–491.

Article Type: Integrative Review

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Description/Results:

* Divides fistula management into 3 phases: (1) recognition and stabilization, (2) anatomic definition and decision, and (3) definitive operation.

* Describes care in each phase with recognition of the importance of the WOC nurse as part of the team.

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What does this mean for me and my practice?

Enhanced knowledge of fistula management from the surgeon's perspective is helpful in supporting patients, especially those waiting for surgical closure.

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O17. Enteral and Parenteral Nutrition in the Conservative Treatment of Pancreatic Fistula: A Randomized Clinical Trial

Klek S, Sierzega M, Turczynowski L, Szybinski P, Szczepanek K, Kulig J. Gastroenterology. 2011;141:157–163.

Article Type: Research Study

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Description/Results:

* 78 subjects with postoperative pancreatic fistulas were randomized to parenteral (n = 40) or enteral (n = 38) nutrition. After 30 days, closure rates of pancreatic fistula in groups receiving enteral and parenteral nutrition were 60% (24 of 40 patients) and 37% (14 of 38 patients), respectively.

* The physiologic reason for these results is that enteral feeding avoids pancreatic stimulation by creating a negative feedback control system and thus inhibiting pancreatic secretion.

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What does this mean for me and my practice?

The reduced cost and decrease in negative side effects of enteral nutrition over parenteral nutrition make these results important to consider in pancreatic fistula management.

Copyright © 2012 by the Wound, Ostomy and Continence Nurses Society

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