Platinum with Vitamin E

Nurse Name: Christine Grimley

Patient Care Setting: The patients care setting was in the community

Patient Overview: The patient was a 78-year-old Female who had her surgery 4 months prior to trialing the firm convex product. She has a permanent Colostomy. Her past medical history includes Atrial Fibrillation on Apixaban, Osteoarthritis, Asthma and Diverticulosis. The patient was admitted as an emergency patient in October 2019 with abdominal pain, vomiting and painless frank hematuria. The patient suffered an obstructed bowel and Diverticular mass stuck in left Iliac Fossa and bladder. The diverticular disease caused obstruction with acute inflammation and fibrosis. She was discharged after 5 weeks in hospital but had a prolonged admission due to management difficulty with stoma and leaking.

Problem: The product that the patient was discharged on was a Peak Medical pouch CLTCO113-44

The patient experienced leakages from her pouch a couple of weeks after being home. Due to a skin shelve above the Colostomy it was difficult for the patient to see the Colostomy and apply her pouch. The patient also experienced painful contact dermatitis as they had a flush stoma. The Colostomy was functioning directly on to peristomal skin issues.

Has been wearing a firm convex pouch and a support garment.

Suspected Cause: The suspected cause of the problem was the flush Colostomy as the stoma mouth was level with mucocutaneous edge and functioning directly on to peristomal skin. Due to the skin shelve above the Colostomy the patient found it difficult to lift the abdomen to see and apply the pouch. The stoma was also in a deep skin crease when she sat forward which caused some pancaking issues.

Course of treatment: The patient was advised to trial the 407412E-FC pre-cut to 25mm. The peristomal skin was treated with Respond Renew protective powder (ABP2) and the Pelican barrier film with Vitamin E (130200E). An ostomy belt was also applied.

The patient had lost confidence and felt deflated after experiencing leakages. Due to the lack of confidence the patient would rush to put her next pouch and would put her pouch on incorrectly. She expressed that she had no quality of life as she would not leave the house. I discussed a home visit with Alison Roberts (Lead Nurse Team Leader and Colorectal Nursing Team) where the patient’s surgery was performed. The surgeon was updated with the patient’s difficulties with managing her stoma. A clinic appointment was then requested by the surgeon to review her Colostomy.

Interventions/complications? The patient had lost confidence and felt deflated after experiencing leakages. Due to the lack of confidence the patient would rush to put her next pouch and would put her pouch on incorrectly. She expressed that she had no quality of life as she would not leave the house. I discussed a home visit with Alison Roberts (Lead Nurse Team Leader and Colorectal Nursing Team) where the patient’s surgery was performed. The surgeon was updated with the patient’s difficulties with managing her stoma. A clinic appointment was then requested by the surgeon to review her Colostomy.

Outcome: After trialing the 407412E-FC the patient experienced no further leakages. The painful contact dermatitis greatly improved and continue to improve. The patient has been advised to continue with the barrier film spray with each pouch change. The pancaking issues have reduced, and regular home visits continue for patient support and peristomal/stoma reviews.

Conclusions: The patient is happy with her new pouch and has seen huge improvement to her peristomal skin. She found the firm convex pouch to be comfortable to wear, her pancaking issues reduced, and she now feels confident to go out with family and friends.

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