Use of Convexity in Ostomy Care: Results of an International Consensus Meeting

Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.

Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex

This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.

Factors associated with leakage in patients with an ostomy: A cross-sectional study

AIMS

To explore the associations between sociodemographic and clinical data, the patient's knowledge and skills, and relationship to healthcare professionals with leakage from an ostomy.

DESIGN

Cross-sectional.

METHODS

This study included 160 patients with a colostomy, ileostomy, or urostomy. Leakage was the dependent variable and was assessed by self-report. Sociodemographic and clinical data and the Ostomy Adjustment Scale subscores, 'knowledge and skills' and 'health care professionals' were independent variables. Spearman's rho and multivariate partial least squares regression analysis were used to estimate possible factors associated with leakage.

RESULTS

Of the participants, 13.8% had leakage weekly or more often, 16.3% more often than once a month and 37, 5% had leakage more seldom than once a month. The most important risk factors for leakage were (1) having an ostomy placement that does not meet international guidelines, (2) not having an optimal relationship with health professionals, (3) having a diagnosis other than cancer, (4) not having proper knowledge and skills in ostomy care, (5) not having a colostomy, (6) having a convex baseplate, (7) having an oval ostomy, and (8) being dependent on others for ostomy care. The independent variables in the PLS- model explained 31% of the variance in leakage.

PATIENT OR PUBLIC CONTRIBUTION

We thank the patients in the user panel for their help during the study.

Use of a Convex Pouching System in the Postoperative Period: A National Consensus

Convex pouching systems have been available for ostomy patients for decades; however, controversy remains over the use of convexity in the postoperative period. A group of 10 nurses and physicians with expertise caring for patients with an ostomy completed a scoping review identifying research-based evidence and gaps in our knowledge of the safety and effectiveness related to the use of a convex pouching system following ostomy surgery. Results of this scoping review demonstrated the need for a structured consensus to define best practices when selecting a pouching system that provides a secure and reliable seal around the stoma, avoids undermining and leakage of effluent from the pouching system, and contributes to optimal health-related quality of life for patients following ostomy surgery. The expert panel reached consensus on 8 statements for the use of convex products immediately after surgery and throughout the first 6 months after stoma creation, as well as describing goals in choosing the best pouching system for the patient with an ostomy.

Survey Results on Use of a Convex Pouching System in the Postoperative Period

PURPOSE

The purpose of this study was to validate time frames for postoperative care following stoma surgery and to determine participants' current practice with convex pouching systems during the postoperative period.

DESIGN

A Cross-sectional survey.

SUBJECTS AND SETTING

The sample comprised 332 ostomy care specialists practicing in the United States. Most (n = 220; 66%) had more than 10 years' experience caring for patients with ostomies, 82% (n = 272) were certified WOC or ostomy care nurses (CWOCN and COCN), and 7% (n = 23) were board-certified colorectal surgeons.

METHODS

A 23-item online questionnaire was created for purposes of the study. Items in the questionnaire queried professional background and experience caring for patients with an ostomy. A single item was used to identify postoperative care periods following ostomy surgery. Additional items queried current practice patterns related to use of convex pouching systems and the timing of their use. Data were collected from January 18 to February 8, 2021.

RESULTS

Most respondents (n = 270; 90%) agreed with the following postoperative periods after ostomy surgery: immediate postoperative period (days 0-8); postoperative period (days 9-30); and transition phase (days 31-180). Most respondents (n = 274; 95%) indicated they would use a convex pouching system when clinically appropriate during the first 30 days following ostomy surgery and 79% (n = 228) indicated using a convex pouching system regardless of when the surgery was performed. Less than 1% (n = 2) indicated never using convexity within the first 30 days following stoma surgery, and only 3% (n = 8) indicated avoidance of convexity pouching systems in the immediate postoperative period.

CONCLUSIONS

Findings indicate that use of convexity during the postoperative period is prevalent to provide a secure seal and predictable wear time.

Factors predictive of optimal peristomal skin status in patients with an ostomy: a secondary analysis

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care.

Characteristics of Convex Skin Barriers and Clinical Application: Results of an International Consensus Panel

Regulatory bodies do not set parameters for measuring certain ostomy product characteristics. As a result, each manufacturer has a different way of measuring specific convex skin barrier characteristics that may create confusion among clinicians when selecting a product. In order to alleviate this confusion and encourage consistency in reporting product characteristics, an international meeting of clinicians with expertise in the care of persons living with an ostomy was convened. The goal of the meeting was to define and establish consistency in convex skin barrier characteristics and their clinical application of the product based on these characteristics. Twelve nurse panelists from 11 countries reviewed, discussed, and reached consensus on a group of proposed statements designed to provide standard definitions of convex skin barrier characteristics and clinically relevant application. The group reached consensus on 5 characteristics of convex skin barriers: depth, compressibility, flexibility, slope, and tension location. These statements provide a basis for quantifying the most clinically relevant characteristics of convex skin barriers and a framework for their application in clinical practice.

Novel stoma appliances to minimise complications and improve patient outcomes

Stomas are created for a number of reasons and, if they are formed without the opportunity for preoperative care and consideration, such as siting, stoma care needs can be more complex in the long term. Patient quality of life can be negatively affected by the incidence of stoma related complications, such as leakage or sore skin. A new range of products, Aura Plus, distributed by CliniMed Ltd in the UK, were evaluated on more than 200 patients with a stoma and assessed for comfort, ease of application, security and leakage. Case studies highlight positive patient outcomes following the use of Aura Plus, and demonstrate how Aura Plus can benefit patients experiencing different needs with their stoma care, such as leakage, peristomal skin complications or a parastomal hernia.

Convexity in stoma care: developing a new ASCN UK guideline on the appropriate use of convex products

One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. However, the use of a convex appliance should be considered only after a thorough assessment has been undertaken by a specialist SCN. Professionally, stoma care nursing has advanced greatly in recent years and there has been a realisation that there is a need for clinical guidelines to direct practice and offer a process for the novice SCN to follow. This realisation has been the catalyst behind the development of the new guideline for the assessment and use of convexity by the Association of Stoma Care Nurses UK, which was published this year (https://ascnuk.com/). This article explores the concept of convexity and how the guideline can assist the practice of specialist SCNs, as well as that of ward and community-based nurses who wish to gain more information on using convexity within the specialist sphere of stoma care.

Patient flow for the management of ostomy patients

Subjects undergoing ostomy are increasing and share a reduced quality of life. The patient flow (PF) is the pathway of a patient from hospital admission to discharge and should provide care appropriateness to the patient himself. In the recent literature no paper exists regarding the PF of the patient undergoing (intestinal or urinary) ostomy, which is the objective of the present article. This paper stems from the work done during the Educational Camp entitled "The Patient Flow in Stoma Care," which took place on three separate days (27^th May, 18^th September, and 21^st November 2019) at B. Braun Milano S.p.A. and regarded 33 stomatherapy nurses from all over Italy supervised by the authors. The participants, divided into heterogeneous groups, developed the PF by means of three specific work methodologies: mental maps, timeline and appreciative inquiry. The elaborated PF was inspired to the International Charter of the Ostomates' Rights. The efficacious and empathic communication and the role of the patient and/or the caregiver as the main characters are transversal to every step and must be always pursued. The PF is developed in eight macro-areas: diagnosis; pre-admission; admission and preoperative phase; surgical operation; awakening; postoperative phase; discharge; follow-up. In agreement with the recent literature, this systematic approach will give benefits to the patients in terms of outcome and perception of taking charge before, during and after the ostomy. At the same time the performances, the therapeutic appropriateness, the optimization of technology and healthcare resources and the staff satisfaction will equally be guaranteed.

Selecting convexity to improve and maintain peristomal skin integrity

Each person with a stoma is an individual who may react differently when faced with similar situations and, as such, each patient needs to be considered on a person-by-person basis to address their needs, support their acceptance of living with a stoma, as well as to encourage their rehabilitation. This article discusses the benefits that a convex flange can offer ostomates to reduce and minimise leakage episodes and in doing so support peristomal skin integrity and, in particular, the benefits of a convex pouch with a hydrocolloid flange containing medical grade Manuka honey. It reports on the findings of an independent nurse study, which included discussions about the varying types of convexity offered to ostomates, following an assessment of patients' needs.

Strengthening implementation success using large-scale consensus decision-making - A new approach to creating medical practice guidelines

A study involving over 2000 stoma care nurses in the development of best practice guidelines for the assessment of peristomal body profiles, patient engagement and patient follow-up was conducted in 2018. The study was designed to develop guidelines for stoma care treatment and product selection and to decrease the evidence to implementation gap. The project built on research evidence from a literature review of 77 articles. The results of the literature review were then used to inform a series of Delphi surveys sent out to stoma care nurses through Association and industry list-serves in 11 languages. The Delphi surveys were followed by a face2face professionally facilitated discussions among nurse-research experts. The project concluded with a facilitated consensus dialogue among 960 stoma care nurses from 25 countries, resulting in an implementation plan to ensure the guidelines become a normal part of routine patient care. The study resulted in a set of medical practice guidelines for stoma care nurses, designed to improve patient outcomes and patient quality of life, that were accepted and adopted into routine medical practice across 25 countries. This article describes the study and how the process used, coined the 'Modified Delphi Process' by the process designer, led to faster implementation than is generally experienced in the medical community.

CE: Stoma and Peristomal Skin Care: A Clinical Review

: Nursing students who don't specialize in ostomy care typically gain limited experience in the care of patients with fecal or urinary stomas. This lack of experience often leads to a lack of confidence when nurses care for these patients. Also, stoma care resources are not always readily available to the nurse, and not all hospitals employ nurses who specialize in wound, ostomy, and continence (WOC) nursing. Those that do employ WOC nurses usually don't schedule them 24 hours a day, seven days a week. The aim of this article is to provide information about stomas and their complications to nurses who are not ostomy specialists. This article covers the appearance of a normal stoma, early postoperative stoma complications, and later complications of the stoma and peristomal skin.

Creating consensus-based practice guidelines with 2000 nurses

Medical professionals follow evidence-based practice guidelines to achieve effective patient outcomes. Traditionally, to develop guidelines, a small group of experts examine evidence then agree on a set of statements, which are then published in journals. However, more than 7000 primary care journal articles are published monthly. This study examined a different way of drawing up practice guidelines, which involved large numbers of nurses from different countries directly in developing then disseminating the guidelines to speed up acceptance and the implementation of best practice. The results were consensus-based best practice guidelines for the treatment of patients with ostomies, which have received a high level of acceptance and enthusiasm from practitioners in 27 countries.