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An ostomy pouch may leak for many reasons, but one common element is skin breakdown. Skin breakdown causes more leakage, in turn causing more skin breakdown. Breaking this cycle by treating the cause and treating the skin is the key to success.
A male patient was admitted the previous shift with fever and decreased level of consciousness. During shift report, the day nurse stated his ileostomy pouch had leaked several times, but it "was ok now." In an early assessment, the night nurse noticed wetness on the patient's gown and discovered his pouch was leaking again. What should be done?
Skin Breakdown
A pouch may leak for many reasons, but one common element is skin breakdown. If the skin is open and moist, the adhesive backing on the pouch or wafer will not stick. Skin breakdown causes more leakage, in turn causing more skin breakdown. Breaking this cycle by treating the cause and the skin is the key to success. Other causes may be pouch overfilling, poor application technique, a poorly fitting pouch (stoma opening cut too large or too small), or dips and crevasses in the skin around the stoma (uneven peristomal plane). Many or all these elements can occur simultaneously (Bowen, 2018; Carmel et al., 2016).
When a pouch is leaking, the effluent (urine or fecal matter based on ostomy type) can damage the skin quickly, and the system must be replaced immediately. Effluent from an ileostomy is especially detrimental to the skin as it contains high amounts of digestive enzymes. The nurse should never plug or patch the leak, or apply tape to the outside border. Identified as peristomal moisture-associated skin damage/irritant contact dermatitis, erythema and skin breakdown may be present. The patient may complain of itching, pain, or a burning sensation. Treatment for intact skin with mild erythema involves application of a non-alcohol skin barrier film.
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