Yvonne Weideman, DNP, MBA, RN, CNE
Assistant Professor, Duquesne University, Pittsburgh, PA
The American Cancer Society estimates that in 2013, 142,820 individuals in the United States will be diagnosed with colorectal cancer and 72,570 with bladder cancer.1,2
Many patients affected by these cancers will require either a temporary or permanent ostomy. During the past decade, changes in ostomy product options offer patients a variety of choices. Knowledgeable nurses who can match a patient’s ostomy needs to the appropriate product ensure that patients experience the highest degree of comfort, ease, and security.
These product decisions fall into four general categories: pouching systems, skin barriers (also called wafers or flanges), pouches, and accessories.
Pouching methods can be either one- or twopiece systems based on whether or not the wafer and pouch are combined into a single unit or function separately. One-piece systems tend to be thinner and more flexible than two-piece systems. 3
This helps the barrier to mold to the body’s contours, making it a good choice for patients with an uneven peristomal skin surface, rods in place, decreased manual dexterity, and/or those who need to streamline the pouching system change procedure. For other patients, a two-piece system is a better option because the pouch can be removed without removing the barrier. Many patients prefer this system, as they are able to change the pouch while only needing to change the full system once or twice a week.4
Options for skin barriers include cut to fit, precut, and convex. Cut-to-fit barriers, where the opening is cut manually, provide a custom fit for each stoma. These barriers are often used in the postoperative period due to the stoma decreasing in size as edema resolves. Once the stoma size and shape stabilizes, a precut barrier where the opening is cut during the manufacturing process may be an option.5 Designed to fit standard round and/or oval stomas, these barriers eliminate several steps in the change procedure; however, they are not designed for stomas that are irregular in shape or size.4
Standard skin barriers have a flat surface on the back, whereas convex barriers have a rounded or curved backing. Convex barriers are used for patients whose stoma is flush to the abdominal surface, retracted below the skin surface, located in a skinfold, or when the stoma opening rests against the abdominal skin.5 The convex shape of the barrier pushes the peristomal skin down, helping the stoma output to be directed into the pouch, versus between the barrier and the peristomal skin causing leakage.