Peristomal Medical Adhesive-Related Skin Injury: Results of an International Consensus Meeting

A Multi-Institutional Study Comparing Stoma Location in Neonates With Intestinal Perforation

INTRODUCTION

Neonates with intestinal perforation often require laparotomy and intestinal stoma creation, with the stoma placed in either the laparotomy incision or a separate site. We aimed to investigate if stoma location is associated with risk of postoperative wound complications.

METHODS

A multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis.

RESULTS

Overall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5).

CONCLUSIONS

Stoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation.

Stoma care and diet in the community

Community nurses are often the common link with people in the community with healthcare services. Community nurses are involved in the care of people living with a temporary or permanent stoma and might be asked specialist questions of which they may feel uncertain of appropriate responses. This article describes some basic facts about stoma as well as specialist dietary considerations; which can be used to improve symptoms such as constipation as well as how to prevent issues such as a food bolus obstruction. An increased understanding of stoma-related dietary needs among community nurses will likely improve care outcomes, as they will feel more equipped to offer tailored guidance and support.

Stoma care: an update

Each year an estimated 13 500 stoma surgeries are carried out in the UK (Kettle, 2019). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.

Assessing and documenting dark skin tones in stoma care

The stoma care nurse (SCN) assesses peristomal skin during each patient intervention. Living in a diverse multicultural society, the SCN needs to consider dark skin tones and how these are documented. This article looks at how the literature on peristomal skin assessment and available tools discuss skin colour, and compare this with the tissue viability literature. Stoma care and peristomal skin literature features very little about skin colour. Registered nurses are often unaware of the differences when assessing light skin tones versus dark skin tones. The article discusses how to assess for, identify and document problems around peristomal skin with patients who have dark skin tones. The differences in skin breakdown between light skin tones and dark skin tones are highlighted. There needs to be further research and development of tools to assist clinicians in identification and documentation relating to skin tone, thus providing consistency in assessment.

Development, Validation, and Usability of the Chatbot ESTOMABOT to Promote Self-care of People With Intestinal Ostomy

This study aimed to describe the process of construction, validation, and usability of the chatbot ESTOMABOT to assist in the self-care of patients with intestinal ostomies. Methodological research was conducted in three phases: construction, validation, and usability. The first stage corresponded to the elaboration of a script through a literature review, and the second stage corresponded to face and content validation through a panel of enterostomal therapy nurses. In the third phase, the usability of ESTOMABOT was assessed with the participation of surgical clinic nurses, patients with intestinal elimination ostomies, and information technology professionals, using the System Usability Scale. The ESTOMABOT content reached excellent criteria of adequacy, with percentages of agreement equal to or greater than 90%, which were considered adequate, relevant, and representative. The evaluation of the content validity of the script using the scale content validity index/average proportion method reached a result above 0.90, and the Fleiss κ was excellent ( P < .05). The overall usability score of the chatbot was 81.5, demonstrating excellent usability. The script, developed and incorporated into the ESTOMABOT prototype, achieved satisfactory content validity. The usability of the chatbot was considered to be good, thereby increasing the credibility of the instrument.

Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme

The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.

Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant: A Case Series

BACKGROUND

Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy.

CASES

Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated.

CONCLUSIONS

For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.

[Eczema of wound surroundings : Genesis, diagnostics and treatment]

Skin changes in the surrounding areas of wounds are a frequently occurring multidisciplinary challenge in the care of patients with wounds, especially in older people. These are often inflammatory skin diseases like eczema that can be caused by various factors. These include allergens, noxa, incorrect skin care or prolonged contact with moisture. In the diagnostics, detailed medical history, clinical examination and allergological tests play important roles. Eczema can mostly be treated symptomatically with topical glucocorticoids. Calcineurin inhibitors are an alternative treatment, especially for longer term topical applications. In cases of impetiginized lesions, appropriate antimicrobial therapy should also be carried out. For long-term and preventive treatment the adequate use of skin care and skin protection products that help to strengthen or restore the skin barrier is decisive as well as the education of the patients and, if necessary, their relatives.

Healing Peristomal Wounds Around Retracted Stomas with Negative-Pressure Wound Therapy: A Case Series

ABSTRACT

One method for treating a retracted stoma is a vacuum dressing that cleans the wound and protects against intestinal leakage. This case series describes the use of an integrated, single-use negative-pressure wound therapy (NPWT) dressing to treat retracted stomas as an alternative to other noninvasive remedies. The report includes seven patients who were hospitalized in the authors' surgical department from 2019 to 2020. All patients developed severe peristomal infection that failed to respond to local treatment with proper ostomy appliances or specialist dressings. After cleaning each wound and removing necrotic lesions, the authors applied a single-use hydrofiber NPWT dressing to each patient. The dressing was changed every 2 to 5 days, depending on the effects of the therapy. The stoma orifice was covered with a bag with two-piece ostomy systems. The peristomal wound healed in all cases, and leakage was eliminated. The mean time of treatment was 14 days (range, 10-21 days), and the vacuum dressings were changed an average of four times (range, 3-7 times). None of the patients required a stoma translocation or other additional surgery. Three patients received systemic IV antibiotic therapy to treat general infection. Single-use NPWT dressings protect peristomal wounds from bowel leakage and do not hinder the application of stoma bags. This system, similar to standard NPWT devices, effectively protects infected stomas from retraction.

Cultural Adaptation, Content Validation, and Reliability of the SACS 2.0 Instrument for Colombian Spanish

OBJECTIVE

To realize the cultural adaptation and content validation and evaluate the reliability of the SACS 2.0 instrument in Colombian Spanish.

METHODS

The researchers conducted a methodological study with a quantitative approach. The adaptation process was carried out in five stages: translation, synthesis, reverse translation, evaluation by a committee of experts, and testing of the adapted version. In addition, the interobserver reliability was evaluated by four nurses who examined 210 stomas.

RESULTS

All of the proposed stages were carried out successfully, and an adapted version of the instrument in Colombian Spanish was obtained. During the content validation stage, the instrument obtained a content validity index of 1. The adapted version of the test showed substantial agreement for the aspect of clarity, adequacy, and understandability. In the interobserver reliability, there was agreement in 95.7% of the evaluations for the classification of the lesions according to the quadrants (κ = 0.97-0.99).

CONCLUSIONS

Authors achieved a culturally adapted, valid, and reliable instrument for the evaluation and classification of peristomal skin alterations in Colombian Spanish.

Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study

BACKGROUND

Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely.

OBJECTIVE

To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain.

DESIGN

Prospective observational multicentre study to assess the diagnostic validity and inter- and intraobserver agreement between nurses in peristomal skin lesions. Data were collected between March and October 2019.

SETTINGS AND PARTICIPANTS

The research sample consisted of a group of 39 nurses with expertise in the care of ostomates.

METHODS

A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement.

RESULTS

A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment.

CONCLUSIONS

The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self-care). It is important to train nurses caring for ostomates to correctly describe ostomy-related lesions, which is important for nursing records, continuity of care and telehealth care.

Expert guidance on prophylaxis and treatment of dermatologic adverse events with Tumor Treating Fields (TTFields) therapy in the thoracic region

Tumor Treating Fields (TTFields) are electric fields, delivered via wearable arrays placed on or near the tumor site, that exert physical forces to disrupt cellular processes critical for cancer cell viability and tumor progression. As a first-in-class treatment, TTFields therapy is approved for use in newly diagnosed glioblastoma, recurrent glioblastoma, and pleural mesothelioma. Additionally, TTFields therapy is being investigated in non-small cell lung cancer (NSCLC), brain metastases from NSCLC, pancreatic cancer, ovarian cancer, hepatocellular carcinoma, and gastric adenocarcinoma. Because TTFields therapy is well tolerated and delivery is locoregional, there is low risk of additive systemic adverse events (AEs) when used with other cancer treatment modalities. The most common AE associated with TTFields therapy is mild-to-moderate skin events, which can be treated with topical agents and may be managed without significant treatment interruptions. Currently, there are no guidelines for oncologists regarding the management of TTFields therapy-related skin AEs in the thoracic region, applicable for patients with pleural mesothelioma or NSCLC. This publication aims to provide guidance on preventing, minimizing, and managing dermatologic AEs in the thoracic region to help improve patient quality of life and reduce treatment interruptions that may impact outcomes with TTFields therapy.

Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective

BACKGROUND

Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care.

METHODS

A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy.

RESULTS

Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery.

CONCLUSIONS

PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare.

A Consensus on Stomal, Parastomal, and Peristomal Complications

OBJECTIVE

To establish a consensus on terminology used to define stomal, parastomal, and peristomal complications in Australia.

METHODS

A list of stomal, parastomal, and peristomal complications was generated through group dialogue, which was informed by clinical and academic knowledge of the researchers. An extensive literature review was undertaken to identify any additional terms and to create a database of definitions/descriptions. A library of images related to the identified conditions was generated. An online Delphi process was conducted among a representative, purposive sample of Australia expert wound, ostomy, and continence nurses and colorectal surgeons. Ten terms were presented to the panel with descriptive photographs of each complication. Up to three Delphi rounds and, if necessary, a priority voting round were conducted.

RESULTS

Seven of the 10 terms reached agreement in the first round. One term ( allergic dermatitis ) was refined ( allergic contact dermatitis ) and reached agreement in the second round. Two terms ( mucocutaneous granuloma and mucosal granuloma ) were considered by the panel to be the same condition in different anatomical locations and were combined as one term ( granuloma ). Two terms ( skin stripping and tension blisters ) were combined as one term ( medical adhesive-related skin injury ) and reached agreement in round 2.

CONCLUSIONS

A consensus in terminology used to describe stomal or parastomal/peristomal complications will enhance communication among patients and health professionals and advance opportunities for education and benchmarking of stomal, parastomal, and peristomal complications nationally.

Evaluación, prevención y tratamiento de MARSI en América latina: reporte del JWC Masterclass

Resumen:

El 13 de julio de 2022, el Journal of Wound Care LATAM (JWC LATAM) presentó su primer Masterclass. Esta clase magistral fue transmitida en vivo, en formato de webinar. Contó con la participación de tres ponentes que abarcaron definición, causas, factores de riesgo y clasificación de MARSI. Describieron, también, cómo determinar quiénes están en riesgo de desarrollar MARSI, qué cuidados tener en cuenta para reducir el riesgo de este tipo de heridas, cuán desarrollado está el concepto de MARSI en América latina, y qué dice la literatura acerca de las mejores prácticas. El siguiente reporte resume los puntos más relevantes.

Conflicto de interés:

Ninguno.

Evaluación, prevención y tratamiento de MARSI en América latina: reporte del JWC Masterclass

Resumen:

El 13 de julio de 2022, el Journal of Wound Care LATAM (JWC LATAM) presentó su primer Masterclass. Esta clase magistral fue transmitida en vivo, en formato de webinar. Contó con la participación de tres ponentes que abarcaron definición, causas, factores de riesgo y clasificación de MARSI. Describieron, también, cómo determinar quiénes están en riesgo de desarrollar MARSI, qué cuidados tener en cuenta para reducir el riesgo de este tipo de heridas, cuán desarrollado está el concepto de MARSI en América latina, y qué dice la literatura acerca de las mejores prácticas. El siguiente reporte resume los puntos más relevantes.

Conflicto de interés:

Ninguno.

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.

Ostomy and Continent Diversion Patient Bill of Rights: Research Validation of Standards of Care

An estimated 725,000 to 1 million people are living with an ostomy or continent diversion in the United States, and approximately 100,000 ostomy surgeries are performed each year in the United States. As a result of ostomy surgery, bodily waste is rerouted from its usual path because of malfunctioning parts of the urinary or digestive system. An ostomy can be temporary or permanent. The ostomy community is an underserved population of patients. United Ostomy Associations of America, Inc (UOAA), is a nonprofit organization dedicated to promoting quality of life for people with ostomies and continent diversions through information, support, advocacy, and collaboration. Over the years, UOAA has received hundreds of stories from people who have received inadequate care. In the United States, patients receiving medical care have certain health rights. For ostomy and continent diversion patients, these rights are known as the "You Matter! Know What to Expect and Know Your Rights-Ostomy and Continent Diversion Patient Bill of Rights" (PBOR). These rights define and provide a guide to patients and health care professionals as to what the best practices are when receiving and providing high-quality ostomy care during all phases of the surgical experience. This includes preoperative to postoperative care and throughout the life span when living with an ostomy or continent diversion. In 2020, the National Quality Forum released "The Care We Need: Driving Better Health Outcomes for People and Communities," a National Quality Task Force report that provides a road map where every person in every community can expect to consistently and predictably receive high-quality care by 2030 (thecareweneed.org). One of the core strategic objectives this report stated is to ensure appropriate, safe, and accessible care. Actionable opportunities to drive change include accelerating adoption of leading practices. The adoption of the PBOR best practices will drive the health care quality improvement change needed for the ostomy and continent diversion population. There are concerns in the ostomy and continent diversion communities among patients and health care professionals that the standards of care outlined in the PBOR are not occurring across the United States in all health care settings. There are further concerns stated by health care professionals that the patient-centered recommendations outlined in the PBOR need to be strengthened by being supported with available published health care evidence. The work of this task force was to bring together members of UOAA's Advocacy Committee, members of the Wound, Ostomy, and Continence Nurses Society (WOCN Society) Public Policy and Advocacy Committee, and representatives from surgical organizations and industry to create a systemic change by validating through evidence the Ostomy and Continent Diversion PBOR. Through the work of the task force, each component of the PBOR has been substantiated as evidence-based. Thus, this article validates the PBOR as a guideline for high-quality standards of ostomy care. We show that when patients receive the standards of care as outlined in the PBOR, there is improved quality of care. We can now recognize that until every ostomy or continent diversion patient receives these health care rights, in all health care settings, will they truly be realized and respected as human rights in the United States and thus people living with an ostomy or continent diversion will receive "the care they need."

Alteration of skin condition in newborns admitted to neonatal intensive care: a concept analysis

OBJECTIVES

to analyze the concept of alteration of skin condition in newborns admitted to the Neonatal Intensive Care Unit.

METHODS

this is a concept analysis operationalized by scoping review. The search was conducted in three parts: the first, in sources like Scopus and Web of Science; the second, in Google Scholar®; and the third, through a parallel list of references.

RESULTS

according to the types of skin, the most frequent alterations were erythema/redness and pressure injuries. The concept analysis was more evident in the attribute "skin lesions or alterations" than the others. The most frequent antecedents were gestational age, birth weight, and factors related to hospitalization. Among the consequences stood out infection/sepsis.

CONCLUSIONS

this study allows improving the vision of health professionals regarding alterations in skin condition of neonates and, therefore, may contribute to a safe and systematized nursing practice.

A new approach with a novel silicone adhesive stoma bag: a clinical study on peristomal skin and quality of life

The care of peristomal skin is a major challenge for people living with a stoma, as well as stoma care nurses. Peristomal skin complications include medical adhesive-related skin injuries/skin stripping, moisture-associated skin damage and contact dermatitis. There is also a limited choice of hydrocolloid adhesive stoma bags. This article reports on the introduction of Genii™, a new stoma bag that sticks with a unique breathable silicone adhesive. The study investigated the experiences of 61 colostomates over a 6-week period, examining the effect on their peristomal skin and their quality of life, in terms of sleep, self-image, social confidence and exercise, and overall product performance. The majority of study participants reported a positive experience when using the stoma bag.

BUNDLE: MEDICAL ADHESIVE-RELATED SKIN INJURY PREVENTION IN ADULT INTENSIVE CARE

ABSTRACT Objective to build and validate a bundle for medical adhesive-related skin injury prevention in adult intensive care. Method this is a methodological study, carried out in three stages: development of a Scoping Review, bundle construction and content validity. This scoping review followed the JBI recommendations, and the content validity process was performed using the Delphi technique. Six expert judges participated in this process. For content validity analysis, the Content Validity Coefficient and binomial test were calculated. Items that reached a coefficient ≥0.80 and an agreement proportion of 80% among judges were considered valid for the binomial test. Results the bundle structure had 21 recommendations, grouped into categories: skin assessment, identification of patients at risk, product selection, skin preparation, adhesive application technique, adhesive removal technique and health professionals’ education. The criteria established for assessment achieved satisfactory levels of assessment, being considered adequate by judges. In Delphi I, the assessed items obtained a Content Validity Coefficient ≥0.83 and in Delphi II, ≥0.97. Conclusion in this study, it was allowed to construct and validate a bundle for medical adhesive-related skin injury prevention in adult intensive care.

BUNDLE: PREVENÇÃO DE LESÕES DE PELE RELACIONADAS A ADESIVOS MÉDICOS EM TERAPIA INTENSIVA ADULTO

RESUMO Objetivo construir e validar um bundle para a prevenção de lesões de pele relacionadas a adesivos médicos em terapia intensiva adulto. Método trata-se de um estudo metodológico, realizado em três etapas: desenvolvimento de uma Scoping Review, construção do bundle e validação de conteúdo. A Scoping Review seguiu as recomendações do Joanna Briggs Institute, e o processo de validação de conteúdo foi realizado, por meio da técnica Delphi. Participaram desse processo seis juízes especialistas. Para a análise da validação de conteúdo, foram calculados o Coeficiente de Validade de Conteúdo e teste binomial. Foram considerados válidos os itens que atingiram coeficiente ≥0,80 e a proporção de concordância de 80% entre os juízes, para o teste binomial. Resultados a estrutura do bundle contou com 21 recomendações, agrupadas em categorias: avaliação da pele, identificação dos pacientes de risco, seleção do produto, preparo da pele, técnica de aplicação do adesivo, técnica de remoção do adesivo e educação permanente dos profissionais de saúde. Os critérios estabelecidos para a avalição alcançaram níveis de avalição satisfatórios, sendo considerados adequados pelos juízes. Em Delphi I, os itens avaliados obtiveram um Coeficiente de Validação de Conteúdo ≥0,83 e em Delphi II, ≥0,97. Conclusão neste estudo, permitiu-se construir e validar bundle, para a prevenção de leões de pele relacionadas a adesivos médicos em terapia intensiva adulto.

Medical adhesive-related skin injury in cancer patients: A prospective cohort study

Objective:

to estimate the incidence of medical adhesive-related skin injury in the peripheral venous catheter fixation region in critical cancer patients, to identify risk factors, and to establish a risk prediction model for its development.

Method:

a prospective cohort study with a sample of 100 adult and aged patients hospitalized in an intensive care unit. The data were analyzed using descriptive, bivariate and multivariate statistics with Cox regression.

Results:

the incidence of medical adhesive-related skin injury was 31.0% and the incidence density was 3.4 cases per 100 people-days. The risk factors were as follows: alcoholism, smoking habit, hospitalization due to deep vein thrombosis, acute respiratory failure, immediate postoperative period, heart disease, dyslipidemia, use of antiarrhythmics, blood transfusion, friction injury, pressure injury, turgor, edema, hematoma, petechiae, low values in the Braden scale, clinical severity of the patient, elasticity, moisture, texture and color. The predictive model consisted in the following: decreased skin turgor, presence of hematoma and edema.

Conclusion:

medical adhesive-related skin injury at the peripheral venous catheter insertion site has a high incidence in critical cancer patients and is associated with decreased turgor, presence of hematoma and edema, evidence that can support the clinical practice.

Effectiveness of Semiocclusive Sodium Carboxymethyl Cellulose Fibers and Hydrocolloid Dressings for Irritant Peristomal Dermatitis: A Case Series

ABSTRACT

The most common complication in individuals with ostomies is irritant contact dermatitis from the acidic stoma effluent coming into contact with the peristomal skin. Although protective powders are widely used for the treatment of peristomal skin, there is little scientific evidence to justify their use. The combined use of sodium carboxymethylcellulose cellulose fibers (SCCFs) together with a hydrocolloid dressing for fixation is an effective alternative in the management of these wounds. Here, the authors report a case series of three patients presenting at a stoma therapy clinic with peristomal skin lesions because of severe irritant contact dermatitis. Patients were men aged between 70 and 81 years, had been diagnosed with colon cancer (n = 2) or bladder cancer (n = 1), and had undergone a colostomy (n = 1), ileostomy (n = 1), or Bricker-type ureteroileostomy (n = 1). A semiocclusive care protocol was applied in a moist environment using SCCF and an extrathin hydrocolloid adhesive dressing, and the collection device was secured using adhesive resin and an ostomy belt. The combined use of SCCF and hydrocolloid dressings provided beneficial results to treat the dermatitis, with reduced discomfort after 7 days and lesions healing within 4 weeks.

Peristomal Skin Health: A WOCN Society Consensus Conference

The Wound, Ostomy, and Continence Nurses (WOCN) Society identified the need to define and promote peristomal skin health. A task force was appointed to complete a scoping literature review, to develop evidence-based statements to guide peristomal skin health best practices. Based on the findings of the scoping review, the Society convened a panel of experts to develop evidence- and consensus-based statements to guide care in promoting peristomal skin health. These consensus statements also underwent content validation using a different panel of clinicians having expertise in peristomal skin health. This article reports on the scoping review and subsequent 6 evidenced-based statements, along with the generation and validation of 19 consensus-based statements, to assist clinical decision-making related to promoting peristomal skin health in adults.

Vascular Ehlers-Danlos Syndrome: Treatment of a Complex Abdominal Wound with Vitamin C and Mesenchymal Stromal Cells

ABSTRACT

Vascular Ehlers-Danlos syndrome (EDSv) can present with life-threatening surgical complications. The article describes the case of a patient with EDSv who developed total abdominal wound dehiscence and multiple enterocutaneous fistulas. Treatment with IV allogeneic mesenchymal stromal cells (MSCs) and high-dose vitamin C was trialed with success. Near-complete wound healing of the abdominal dehiscence with a 94% reduction in the size of the wound bed occurred. Maturation of the enterocutaneous fistulas also ensued.There is no current consensus on the management of large cutaneous wounds in EDSv. This article discusses the pathophysiology of wound healing with regard to nutrition requirements and growth factors with special reference to collagen deficits in EDSv. A potential therapy with IV vitamin C supplementation and MSCs is proposed following the patient's positive outcome. Medium-dose MSCs and high-dose IV vitamin C may offer significant benefits to complex and problematic wounds.

Using a novel breathable silicone adhesive (Sil2 technology) in stoma appliances to improve peristomal skin health: answering the key questions

Fiona Le Ber answers some of the questions that stoma care nurses may have regarding this novel silicone adhesive based technology, which helps to avoid medical adhesive related skin injury (MARSI) and moisture-associated skin damage (MASD). Whereas hydrocolloid stoma appliances absorb moisture, this has a non-absorptive method of moisture management that prevents peristomal skin becoming damp and excoriated.

Use of breathable silicone technology in an ostomy appliance flange

Leaks and peristomal skin complications are highly prevalent among people with a stoma, reported by over 80% of ostomates within 2 years of surgery. This suggests that there is room for improvement in ostomy appliances, particularly in their hydrocolloid-based adhesive flanges. Hydrocolloid has an absorptive method of moisture management that, over time, risks maceration and skin stripping, potentially leading to moisture-associated skin damage (MASD) and medical adhesive-related skin injury (MARSI). The newly developed Genii ostomy appliances (Trio Healthcare) use novel Sil2 Breathable Silicone Technology to provide secure, effective adhesion and manage moisture levels by replicating natural transepidermal water loss (TEWL). This has the potential to increase appliance wear time, reduce incidence of MASD and permit atraumatic removal without adhesive remover, reducing the risks of MARSI, as well as time burdens on the user and economic burdens on the healthcare system. Meanwhile, the silicone flanges and water-resistant sports fabric pouches are lightweight, flexible and unobtrusive, and they are the first appliances to be available in colours to match different skin tones, all of which provides security, comfort, confidence and discretion. This article explores the features of Sil2 and Genii ostomy appliances, with reference to preliminary data from a user evaluation.

Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH

Wund-D.A.CH., as the umbrella organization of German-speaking wound treatment societies, has currently developed a best practice recommendation for skin damage caused by body fluids, which is known as moisture-associated skin damage (MASD) in English-speaking countries. In this expert consensus, the diseases incontinence-associated dermatitis (IAD), intertriginous dermatitis, including intertrigo, gram-negative bacterial toe web infection and toxic contact dermatitis, including periwound and peristomal dermatitis are presented in a differentiated manner. A common feature of these clinical diseases is a deterioration of skin integrity due to prolonged exposure to body fluids such as urine, stool, sweat or wound exudate with associated physical-irritative and/or chemical irritation. In addition, other comorbidities and cofactors play an important role. The diagnosis of these interdisciplinary and interprofessionally relevant MASD is difficult in everyday clinical practice because there are currently no uniform definitions and many relevant differential diagnoses. Effective strategies for the prevention and therapy of these skin diseases are, for example, continence management, use of efficient, absorbent aids with good retention as well as consistent skin protection and adequate skin care. Another important aspect is the education of patients and relatives about the origin, treatment and prevention of MASD.

Using a novel breathable silicone adhesive (Sil2 technology) in stoma appliances to improve peristomal skin health: answering the key questions

Fiona Le Ber answers some of the questions that stoma care nurses may have regarding this novel silicone adhesive based technology, which helps to avoid medical adhesive related skin injury (MARSI) and moisture-associated skin damage (MASD). Whereas hydrocolloid stoma appliances absorb moisture, this has a non-absorptive method of moisture management that prevents peristomal skin becoming damp and excoriated.

Use of breathable silicone technology in an ostomy appliance flange

Leaks and peristomal skin complications are highly prevalent among people with a stoma, reported by over 80% of ostomates within 2 years of surgery. This suggests that there is room for improvement in ostomy appliances, particularly in their hydrocolloid-based adhesive flanges. Hydrocolloid has an absorptive method of moisture management that, over time, risks maceration and skin stripping, potentially leading to moisture-associated skin damage (MASD) and medical adhesive-related skin injury (MARSI). The newly developed Genii ostomy appliances (Trio Healthcare) use novel Sil2 Breathable Silicone Technology to provide secure, effective adhesion and manage moisture levels by replicating natural transepidermal water loss (TEWL). This has the potential to increase appliance wear time, reduce incidence of MASD and permit atraumatic removal without adhesive remover, reducing the risks of MARSI, as well as time burdens on the user and economic burdens on the healthcare system. Meanwhile, the silicone flanges and water-resistant sports fabric pouches are lightweight, flexible and unobtrusive, and they are the first appliances to be available in colours to match different skin tones, all of which provides security, comfort, confidence and discretion. This article explores the features of Sil2 and Genii ostomy appliances, with reference to preliminary data from a user evaluation.

Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary

PURPOSE

This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults.

METHODS

Scoping review and generation of evidence and consensus-based clinical guidelines.

SEARCH STRATEGY

The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication.

FINDINGS/CONCLUSIONS

This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

Preoperative Stoma Site Marking Decreases Stoma and Peristomal Complications: A Meta-analysis

PURPOSE

We systematically reviewed the literature in order to determine whether evidence indicated that preoperative stoma site marking reduces the occurrence of postoperative stoma and peristomal complications.

DESIGN

Systematic review with meta-analysis of pooled findings.

SUBJECTS/SETTING

We systematically reviewed 6 electronic databases including PubMed, MEDLINE, CINAHL, Cochrane Library for English language articles, along with the Airiti Library and Wanfang Data for Chinese articles for evidence related to the effects of stoma site marking on stoma and peristomal complications. We sought articles published from their inception to January 31, 2018.

METHODS

Ten studies that included 2109 participants, each comparing 2 groups of patients who did and did not undergo preoperative stoma site marking, were retrieved and analyzed.

RESULTS

In patients who underwent stoma site marking, the marking was associated with reduced stoma and peristomal complications in all stoma types (odds ratio [OR] = 0.52; 95% CI, 0.42-0.64; P < .001). Patients who underwent stoma and had fecal ostomies experienced fewer complications (OR = 0.34; 95% CI, 0.25-0.47; P < .001) than patients with unmarked stomas. In contrast, patients with urostomies did not experience fewer complications when compared to those with unmarked ostomies (OR = 0.531; 95% CI, 0.23-1.21; P = .132). Persons with fecal ostomies also had fewer hernias and peristomal skin complications (ORs = 0.25 and 0.30; 95% CIs, 0.09-0.71 and 0.20-0.44, respectively; both Ps < .001). The results revealed that stoma site marking was associated with reduced early and late stoma and peristomal complications (ORs = 0.76 and 0.38; 95% CIs, 0.61-0.94 and 0.32-0.46; P = .010 and P < .001, respectively).

CONCLUSIONS

Preoperative stoma site marking is associated with a reduced occurrence of stoma and peristomal complications and should be considered as a standard of preoperative care.

Using a novel breathable silicone adhesive (Sil2™ technology) in stoma appliances to improve peristomal skin health: answering the key questions

Fiona Le Ber answers some of the questions that stoma care nurses may have regarding this novel silicone adhesive based technology, which helps to avoid medical adhesive related skin injury (MARSI) and moisture-associated skin damage (MASD). Whereas hydrocolloid stoma appliances absorb moisture, this has a non-absorptive method of moisture management that prevents peristomal skin becoming damp and excoriated

Medical adhesive-related skin injury

The skin's main function is to act as a physical barrier against harmful substances. Medical adhesive-related skin injury (MARSI) is a prevalent and under-reported condition that compromises the skin's integrity. Repeated applications and removal of appliances can increase the likelihood of MARSI occurring. Prevention and treatment are key to ensure appropriate skin preparation, product appliance and removal. The use of structured approaches is imperative and there is a need to increase the awareness of MARSI among patients and health professionals to ensure that informed decisions are made.