Vol. 2 No. 3 (2023): infermieristica journal: your heart, our beat
Articles

Peristomal skin changes: therapeutic education on prevention and nursing interventions on management

Gloria Dorigo
Stomatherapist Nurse and Wound Care Expert, ULSS 6 Euganea (PD), Italy

Published 2023-10-31

Keywords

  • Wound Care,
  • Wound Management,
  • Peristomal Skin Complications,
  • Education,
  • Nursing interventions,
  • Dressing
  • ...More
    Less

Abstract

Introduction: for the person with an ostomy it is very important to have intact peristomal skin, because there is a certainty that the ostomy pouching system adheres to the skin; on the other hand, with altered skin there is a greater risk that the ostomy pouching system detaches with consequent infiltration of the effluents and contact with the peristomal skin, showing skin alterations and further compromising the person's quality of life.

Materials and methods: the bibliographic research conducted on PubMed detecting 47 publications that answered to the 2 research questions, under 10 years, with a sample of more than 50 adult participants and in English language.

Results: to define therapeutic education strategies to prevent peristomal skin complications and the most appropriate nursing interventions and dressing to manage peristomal skin complications.

Conclusion: a preventive therapeutic education with detailed, simple, adequate information and perhaps supported by printed information leaflets regarding peristomal skin complications will be able to reduce the incidence of peristomal skin changes, because the person with an ostomy will be able to recognize early the signs and symptoms of altered skin and manage them at home, thanks to the guidelines provided by  the specialist nurse. In addition, the specialist nurse can effectively put to good use the expertise acquired through the treatment of peristomal skin complications, preventing the patient from suffering further side effects and speeding up the healing process, which is the main goal.

References

  1. H. Nybaek, GBE. Jemec "Skin problems in stoma patients" from the Journal European Academy of Dermatology and Venereology of 2010; 24, 249–257 .
  2. Maria Teresa Szewczyk, Grazyna Majewska, Mary V. Cabral, Karin Hölzel-Piontek “The Effects of Using a Moldable Skin Barrier on Peristomal Skin Condition in Persons with an Ostomy: Results of a Prospective, Observational, Multinational Study” from Ostomy Wound Management of 2014 ; 60(12):16–26.
  3. Paula Erwin-Toth, Linda J. Stricker, Lia van Rijswijk “Peristomal Skin Complications” from the 2010 American Journal of Nursing ; Vol. 110, No. 2.
  4. Hanne Nybaeka, Dorte Bang Knudsenb, Troels Norgaard Laursenb, Tonny Karlsmarkc and Gregor BE Jemeca “Quality of life assessment among patients with peristomal skin disease” from the European Journal of Gastroenterology & Hepatology of 2010; 22: 139–143.
  5. Ginger D. Salvadalena “The Incidence of Stoma and Peristomal Complications During the First Three Months After Stoma Creation” from the 2013 Journal Wound Ostomy Continence Nurse ; 40(4):400-406 .
  6. Charu Taneja, Debra Netsch, Bonnie Sue Rolstand, Gary Inglese, Lois Lamerato, Gerry Oster “Clinical and economic burden of peristomal skin complications in patients with recent ostomies” from the Journal Wound Ostomy Continence Nurse del 2017;44(4):350-357.
  7. Janice C. Colwell, Catherine R. Ratliff, Margaret Goldberg, Mona M. Baharestani, Donna Z. Bliss, Mikel Gray, Karen L. Kennedy-Evans, Susan Logan, Joyce M. Black “MASD Part 3: Peristomal Moisture–Associated Dermatitis and Periwound Moisture–Associated Dermatitis” from the 2011 Wound Ostomy Continence Nurses Journal ; 38(5):541-553 .
  8. Lina Martins, Kathy Tavernelli, Wendy Sansom, Kirsten Dahl, Ineke Claessens, Terri Porrett and Birgitte Dissing Andersen “ Strategies to reduce treatment costs of peristomal skin complications ” from the British Journal of Nursing 2012 ; Vol 21, No 22.
  9. Konrad M. Szymanski, Diane St-Cyr, Tarik Alam and Wassim Kassouf "External Stoma and Peristomal Complications following Radical Cystectomy and Ileal Conduit Diversion: A Systematic Review" from Ostomy Wound Management 2010 ; 56(1):28-35.
  10. Jennie Burch “Care of patients with peristomal skin complications” from Nursing standard of 2014 ; vol. 28, no. 37, 51-57.
  11. Sherry Lynn Werth, Debra L. Schutte, Manfred Stommel “Bridging the Gap Perceived Educational Needs in the Inpatient to Home Care Setting for the Person With a New Ostomy” from Wound Ostomy Continence Nurse 2014; 41(6):566-572 .
  12. Jennie Burch “Peristomal skin care and the use of accessories to promote skin health” from the 2011 British Journal of Nursing ; Vol 20, No 7 Apr 14-27;20(7):S4, S6, S8
  13. Park, Seungmi Lee, Yun Jin Oh, Doo Nam Kim, Jiyun “ Comparison of Standardized Peristomal Skin Care and Crusting Technique in Prevention of Peristomal Skin Problems in Ostomy Patients” from Journal of Korean Academy of Nursing of 2011 ; Vol. 41, NO.6, pp. 814-820.
  14. Julia Williams, Brandon Gwillam, Norma Sutherland, Jane Matten, Julie Hemmingway, Helen Ilsey, Mary Somerville, Angela Vujnovich, Stephanie Day, Caroline Redmond, Caroline Cowin, Kathy Fox, Theresa Parker “Evaluating skin care problems in people with stomas” from the British 2010 Journal of Nursing ; Vol 19, No 17.
  15. Catherine R. Ratliff “Early Peristomal Skin Complications Reported by WOC Nurses” from Journal Wound Ostomy Continence Nurse 2010 ; 37(5):505-510 .
  16. Ginger D. Salvadalena “The Incidence of Stoma and Peristomal Complications During the First 3 Months After Ostomy Creation” from Wound Ostomy Continence Nurse 2013; 40(4):400-406 .
  17. Stacy Recalla, Kim English, Rishma Nazarali, Samantha Mayo, Debbie Miller, Mikel Gray “Ostomy Care and Management” from the 2013 Wound Ostomy Continence Nurse; 40(5):489-500 .
  18. Kimberly LeBlanc, Ian Whiteley, Laurie McNichol, Ginger Salvadalena, Mikel Gray “ Peristomal Medical Adhesive–Related Skin Injury” from the Journal Wound Ostomy Continence Nurse del. 2019;46(2):125-136.
  19. Maydick -Youngberg “A descriptive study to explore the effect of peristomal skin complications on quality of life of adults with a permanent ostomy” from Ostomy wound Management of May 2017; 63(5):10-23.
  20. Ratliff CR “ Early peristomal skin complications reported by WOC Nurses” from Journal Wound Ostomy Continence Nurse. of the 2010 Sep-Oct;37(5):505-10.
  21. Baykara ZG , Demir SG , Karadag A. , Harputlu D. , Kahraman A. , Karadag S. , Hin AO ., Togluk E. , Altinsoy M. , Erdem S ., Cihan R. _ “ A multicenter, retrospective study to evaluate the effect of preoperative stoma site marking on stomal and perostomal complications” from Ostomy wound Management of May 2014; 60(5):16-26.
  22. Lina Martins, Elizabeth A Ayello, Ineke Claessens, Anne Steen Hansen, Lis Hentze Poulsen, R Gary Sibbald, Gregor B Jemec “The Ostomy Skin Tool: tracking peristomal skin changes” from the 2010 British Journal of Nursing ; Vol 19, No 15.
  23. Vicki Haugen, Catherine R. Ratliff “Tools for Assessing Peristomal Skin Complications” from Wound Ostomy Continence Nurse 2013; 40(2):131-134 .
  24. GB Jemec, L. Martins, I. Claessens, EA Ayello, AS Hansen, LH Poulsen and RG Sibbald "Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool" from the British Association of dermatologists of 2011; 164, pp. 330–335.
  25. Soren Meisner, Paul-Antoine Lehur, Brendan Moran, Lina Martins, Gregor Borut Ernst Jemec “Peristomal Skin Complications Are Common, Expensive, and Difficult to Manage: A Population Based Cost Modeling Study” from the 2012 PLoS ONE; vol. 7 issue 5.
  26. Jane V. Arndt, Teresa J. Kelechi “ An Overview of Instruments for Wound and Skin Assessment and Healing ” from Wound Ostomy Continence Nurse of 2014 ; 41(1):17-23.
  27. Menin G. , Roveron G. , Barbierato M. , Peghetti A. , Zanotti R. “Design and validation of a "Peristomal Lesion Scale" for peristomal skin assessment” from Int Wound J. of April 2019;16(2):433-441.
  28. Kevin Y. Woo, R. Gary Sibbald, Elizabeth A. Ayello, Patricia M. Coutts, Dianne E. Garde “P eristomal Skin Complications and Management” ADVANCES IN SKIN & WOUND CARE 2009;22:522-32
  29. Susan Stelton , Karen Zulkowski , Elizabeth A. Ayello “Practice Implications for Peristomal Skin Assessment and Care from the 2014 World Council of Enterostomal Therapists International Ostomy Guideline” from the 2015 WOUND CARE JOURNAL ; 28:275–284.
  30. Emily Steinhagen, Janice Colwell, Lisa M. Cannon “ Intestinal stomas — postoperative stoma care and peristomal skin complications” Clin Colon Rectal Surg 2017 ;30:184 – 192.
  31. AM. Ippolito, P. Lui, R. Cassino, P. Cuffaro, MT Scalise, M. D'Elia, R. Ravaldi, S. Mori, B. Ritrovato, O. Forma, A. Corsi, M. Pierangeli "The skin : identification of criteria for correct management” ACTA VULNOL 2012;10:1-2
  32. Rippon M , Perrin A. Darwood R , Ousey K “The potential benefits of using aloe vera in stoma patient skin care” by Br J Nurs . of the 2017 Mar 9;26(5):S12-S19.
  33. Stephen-Haynes J. “The outcomes of barrier protection in periwound skin and stoma care” by Br J Nurs. of the 2014 Mar 13-26; 23(5):S26, S28-30.
  34. Szewczyk MT , Majewska G , Cabral MV , Hölzel-Piontek K “ The effects of using a moldable skin barrier on peristomal skin condition in persons with anostomy: results of a prospective, observational, multinational study ” Ostomy Wound Manage del 2014 Dec;60(12):16-26.
  35. White P , Evans M “Clinical governance for ostomates at risk of peristomal skin complications” by Br J Nurs. of the 2019 Sep 12;28(16):S24-S32.
  36. Claudia Caula and Alberto Apostoli "Care and assistance to patients with acute wounds and chronic ulcers" from The nurse and his profession of 2017
  37. Afifi L , Sanchez IM , Wallace MM , Braswell SF , Ortega- Loayza AG , Shinkai K “Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review” from J Am Acad Dermatol. of the 2018 Jun;78(6):1195-1204
  38. Pearson WA , Prentice DA . , Sinclair D.L. , Lim LY , Carville KJ “A novel topical therapy for resistant and early peristomal pyoderma gangrenous” Int wound J. 2019 Oct;16(5):1136-1143.
  39. DeMartyn LE , Faller NA , Miller L “Treating peristomal pyoderma gangrenosum with topical crushed prednisone: a report of three cases” Ostomy Wound Manage. 2014 Jun ;60 (6):50-4.
  40. Taylor L. “ Peristomal sore skin: assessing the effect of an alginate wafer” Br J Nurs . 2012 Sep 13-26 ;21 (16):S41-2, S44-6.
  41. Irina Blumenstein, Dietmar Borger, Stefan Loitsch , Christiane Bott , Angelika Tessmer , Franz Hartmann, Jürgen Stein “A Glycerin Hydrogel - Based Wound Dressing Prevents Peristomal Infections After Percutaneous Endoscopic Gastrostomy (PEG)” published: 20 April 2012 Ostomy wound management
  42. Charousai F. _ , Dabirian A. , Mojab F. _ “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” Ostomy Wound Manage. 2011 May ;57 (5):28-36.
  43. Wells GL . , Brown J. , Manganiello WD ., Chapman MS . “Tacrolimus ointment 0.1% for the treatment of peristomal skin disease: 3 case reports” Cutis. 2006 Oct ;78 (4):258-60 .
  44. By Sabine Ellinger “Micronutrients, arginine, and glutamine: does supplementation provide an efficient tool for prevention and treatment of different kinds of wound?” Adv around Care (New Rochelle ) 2014 Nov 1 ;3 (11):691-707 .
  45. By Agnieszka Wojcik, Marlis Atkins, Diana R. Mager “Dietary intake in clients with chronic wounds” Can J Diet Practice Res. 2011 Summer;72(2):77-82.
  46. By Mary Ellen Posthauer “The role of nutrition in wound care” Adv Skin wound care 2006 Jan-Feb;19(1):43-52;
  47. Association of stoma care nurses ASCN “Clinical guidelines” 2016;
  48. Atkin L., et al, Implementing TIMERS: the race against hard-to-heal wounds, JWC, 2019.
  49. Villa G., et al, SaCS evolution: a peristomal health tool for the prevention of peristomal skin disorders, Minerva Surg, 2021.