Peristomal Skin Assessment Guide for Consumers

Manage Probable Causes

Check Barrier for Overhydration (softening and whitening)

Remove pouching system and assess adhesive side of skin barrier; if there is significant overhydration of the barrier, change pouching system more frequently.

Check Barrier/Pouching System Fit

Ensure skin barrier opening is sized to fit closely around stoma base.

How to Measure your Stoma:

Ensure Barrier Provides Good Fit for Stoma and Abdominal Surface

• Examine your stoma and the skin around your stoma in the standing and sitting positions. Check to see if your stoma sticks out in those positions. Check to see if you have creases or folds in the skin around your stoma in either position.
• If your stoma does not stick out AND/OR you have creases or folds in the skin around your stoma, consider a convex pouching system and/or ostomy belt.
• Consult a WOC nurse/NSWOC or product manufacturer should you wish to discuss these options.

Peristomal Skin Care for Waterlogged Skin

Dust waterlogged skin with stoma powder; brush off excess (if too much powder remains on the skin, the barrier may not stick). Do this during each pouching system change until the skin recovers.
Assess adhesive side of barrier and skin at each pouch change. If the barrier appears overhydrated or the skin is waterlogged, change pouching system more often.

Discontinue use of stoma powder when problem resolves/skin recovers.

Seek Help

Consult a WOC nurse/NSWOC and/or product manufacturer:

• If no improvement after 7 days of management
• Probable contributing factors unclear or not identified

Tips for Better Skin Care

• Change pouching system on a consistent schedule.
• Change pouching system if there is peristomal itching and/or burning.
• Change pouching system if the skin barrier leaks or loosens.

Manage Probable Causes

Check Barrier/Pouching System Fit

Ensure skin barrier opening is sized to fit closely around stoma base.

How to Measure your Stoma:

Ensure Barrier Provides Good Fit for Stoma and Abdominal Surface

• Examine your stoma and the skin around your stoma in the standing and sitting positions. Check to see if your stoma sticks out in those positions. Check to see if you have creases or folds in the skin around your stoma in either position.
• If your stoma does not stick out, consider using a convex pouching system and/or ostomy belt.
• If you have creases or folds in the skin around your stoma, consider a barrier ring, convex pouching system, and/or ostomy belt.
• If your stoma does not stick out AND you have creases or folds in the skin around your stoma, consider a barrier ring, convex pouching system, and/or ostomy belt.
• How to use ostomy belt:

• If you have liquid stool, consider adding a barrier ring.
• How to use barrier rings:

• Consult a WOC nurse/NSWOC or product manufacturer should you wish to discuss these options.

Frequency of Pouching System Change

• Change pouch when leaking; do not reinforce with additional tape.
• Assess adhesive side of skin barrier at each pouch change for evidence that stool/urine is leaking under the barrier. If there is evidence of leakage, change pouching system more often.
• If you experience burning, itching or leakage, change barrier immediately.

Peristomal Skin Care for Irritated Skin

Dust irritated skin with stoma powder; brush off excess (if too much powder remains on the skin, the barrier may not stick). Do this during each pouching system change until the skin recovers.

Discontinue use of stoma powder when problem resolves/skin recovers.

Seek Help

Consult a WOC nurse/NSWOC and/or product manufacturer:

• If no improvement after 7 days of management
• Probable contributing factors unclear or not identified

Tips for Better Skin Care

• Change pouching system on a consistent schedule.

• Change pouching system if there is peristomal itching and/or burning.
• Change pouching system if the skin barrier leaks or loosens.

Manage Probable Causes

Check Barrier for Overhydration (softening and whitening)
Remove pouching system and assess adhesive side of skin barrier; if there is significant overhydration of the barrier, change pouching system more frequently.

Check Barrier/Pouching System Fit
Ensure skin barrier opening is sized to fit closely around stoma base.

How to Measure your Stoma:

Wetness Under Pouching System
Thoroughly dry the tape border and pouch backing after bathing, swimming, etc.
Consider a pouch cover to manage perspiration and/or moisture under plastic pouch.

Peristomal Skin Care for Fungal Rash

Antifungal Powder Dust powder on affected area with each pouch change. Brush off excess (if too much powder remains on the skin, the barrier may not stick). Avoid using antifungal cream or ointment under the barrier.

Change pouching system and use antifungal powder at least every 3-4 days for 2 weeks.

Discontinue use of antifungal powder when problem resolves/skin recovers.

Seek Help

Consult a WOC nurse/NSWOC and/or product manufacturer if no improvement after 14 days of treatment.

Tips for Better Skin Care

• Change pouching system on a consistent schedule.
• Change pouching system if there is peristomal itching and/or burning.
• Change pouching system if the skin barrier leaks or loosens.
• Dry pouching system well after bathing, swimming, or contact with water or steam

Manage Probable Causes

Skin Barrier and/or Tape (Adhesive) Removal Technique

• Starting at the top, with one hand, gently lift the edge of the adhesive product; with the other hand, gently push the skin away from the adhesive.

• Consider use of adhesive removers/releasers.
• Downloadable tips (PDF) for Medical Adhesive Remover Spray/ Universal Remover Wipe

Peristomal Skin Care for Adhesive Related Skin Injury

Treatment of open areas (if any)
Dust open areas with stoma powder; brush off excess (if too much powder remains on the skin, the barrier may not stick). Do this during each pouching system change until the skin recovers.

Trim adhesive border of pouching system to avoid injured skin.

Discontinue use of stoma powder when problem resolves/skin recovers.

Seek Help

Consult a WOC nurse/NSWOC and/or product manufacturer:

• If no improvement after 7 days of treatment

Tips for Better Skin Care

• Change pouching system on a consistent schedule.
• Change pouching system if there is peristomal itching and/or burning.
• Change pouching system if the skin barrier leaks or loosens.

Manage Probable Causes

Skin Barrier and/or Tape (Adhesive) Removal Technique

• Starting at the top, with one hand, gently lift the edge of the adhesive product; with the other hand, gently push the skin away from the adhesive.

• Consider use of adhesive removers/releasers.
• Downloadable tips (PDF) for Medical Adhesive Remover Spray/ Universal Remover Wipe

Hair Removal
Before putting on the pouching system, some people find it helpful to remove hair in the peristomal area. This helps to prevent trauma to the hair follicle upon the next pouching system change. Clipping with scissors or use of disposable or electric razors are recommended; frequency dependent on rate of hair growth.

Peristomal Skin Care for Folliculitis

Skin Cleansing
Clean with mild antibacterial soap at each pouching system change. Rinse thoroughly. Continue using mild antibacterial soap until bumps/pimples have resolved.

Treatment of open areas (if any)
Dust open areas with stoma powder; brush off excess (if too much powder remains on the skin, the barrier may not stick). Do this during each pouching system change until the skin recovers.

Discontinue use of stoma powder when problem resolves/skin recovers.

Seek Help

Consult a WOC nurse/NSWOC and/or product manufacturer if no improvement after 14 days of treatment.

Tips for Better Skin Care

• Change pouching system on a consistent schedule.
• Change pouching system if there is peristomal itching and/or burning.
• Change pouching system if the skin barrier leaks or loosens.

Referral

• Report problem to your physician or other provider (Nurse Practitioner or Physician’s Assistant).
• Contact a WOC nurse/NSWOC.

Interim Interventions

If unable to maintain pouch seal for 24 hours:

Ensure Barrier Provides Good Fit for Stoma and Abdominal Surface

• Examine your stoma and the skin around your stoma in the standing and sitting positions. Check to see if your stoma sticks out in those positions. Check to see if you have creases or folds in the skin around your stoma in either position.
• If your stoma does not stick out, consider using a convex pouching system and/or ostomy belt.
• If you have creases or folds in the skin around your stoma, consider a barrier ring, convex pouching system, and/or ostomy belt.
• If your stoma does not stick out AND you have creases or folds in the skin around your stoma, consider a barrier ring, convex pouching system, and/or ostomy belt.
• How to use ostomy belt:

• If you have liquid stool, consider adding a barrier ring.
• How to use barrier rings:

• Contact a WOC nurse/NSWOC or product manufacturer should you wish to discuss these options.

Change pouch when leaking; do not reinforce with additional tape.

If you have an ulcer or full thickness skin loss (crater):

• Rinse open area with saline or tap water.
• Fill area with stoma powder. Dust powder on area of skin loss and brush away excess.

• Cover powder with a flattened piece of skin barrier ring, if available. If not, follow steps below.
• Ensure skin barrier opening is sized to fit closely around stoma base.
• Apply pouching system on top of open area treated with stoma powder.

If your ulcer or full thickness skin loss (crater) has purulent (pus) drainage:

• Evaluate for other signs of infection (for example, elevated temperature, chills, decreased appetite, nausea or vomiting) and include in report to the physician or other provider.
• Rinse open area with saline or tap water.
• Fill any open areas with stoma powder. Dust powder on area of skin loss and brush away excess.
• Ensure skin barrier opening is sized to fit closely around stoma base.
• Apply pouching system on top of open area treated with stoma powder.
• Report this information to physician or other provider.