Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Products Considerations
Generic Categories Description of products Indications Contraindications/
Precautions
Pouching systems
  • One piece – skin barrier and pouch are as one
  • Two piece – skin barrier and pouch adheres or snaps onto skin barrier
Factors to consider in selecting pouching system
  • Type & consistency of effluent
  • Stoma size & construction
  • Manual dexterity & visual acuity
  • Level of physical activity
  • Financial resources
  • Preferences
 
Skin barrier Made of synthetic polymers or natural material (karaya) to protect the skin from effluent. Can be:
  • Flat or convex
  • Regular or extended wear
  • With or without tape
  • Mandatory to protect the peristomal skin
  • Poorly protruding stomas:
    Convex barriers may be effective
  • Sensitive skin or skin allergies:
    Tapeless barrier or karaya barriers may be effective
  • Use convexity with caution on post-operative ostomies or parastomal hernias
  • Floating, stationary or no flange
  • Pre-cut or cut-to-fit or moldable opening
  • Available in size adapted to premature neonate and children
  • Some pediatric skin barriers are available without starter hole
  • New post-operative clients:
    Floating barriers help to reduce pressure and pain on the abdomen when attaching the pouch to the barrier
  • Cut to fit barrier may be appropriate with clients with poor dexterity
  • Precut barriers are not recommended for oval stomas
  • Paediatric skin barriers have a tendency to melt more rapidly; are more flexible, and less resistant
Pouch Various sizes including neonates and children’s sizes
  • Drainable
  • Closed end
  • High output
  • Clip, Velcro closure or spout
  • Clear, opaque
  • Gas filter
  • Dependent on personal choice
  • Urostomy systems have an anti-reflux mechanism to prevent urine backing up
  • Filters can be beneficial for clients with increased flatus
  • Special adaptors required for high-output and urinary pouches when connecting to straight drainage
  • Filters can become clogged when effluent is liquid; Filters not recommended immediately post-op
  • Opaque pouches not recommended immediately post-op
Powder
  • Powder made from skin barrier material
  • Absorbs moisture from weepy peristomal skin to promote barrier adhesion
  • Assists in the removal of paste
  • Fills mucocutaneous separation defects
  • Not required on intact persistomal skin
Fillers
  • Paste*
  • Strip paste
  • Ring
  • Rings:
    • Pre-cut
    • Moldable
    • Convex
  • Used to fill skin creases and uneven skin surfaces
  • Decreases leakage of effluent under the barrier
  • To add convexity to a barrier
  • * Paste is a filler, not glue
  • Most pastes contain alcohol; Cautious use on denuded skin
  • Use alcohol-free paste in premature neonates
Sealants
  • Wipes
  • Sprays
  • In clients who have known sensitivity to adhesive products
  • Skin conditions such as eczema
  • Skin changes due to chemotherapy
  • Prevent skin stripping
  • Can be used to waterproof the skin barrier
  • Contraindicated with extended-wear barriers
  • Contraindicated on denuded skin unless alcohol-free products
  • Non-alcohol products are recommended on premature neonates
Adhesive removers
  • Wipes
  • Build up of adhesive
  • Hypersensitive skin: pain with product removal
  • Denuded skin
  • Premature neonates
Belt
  • Available in adult/pediatric sizes
  • To increase barrier stability
  • For clients who are physically active and for intimate situations if needed
  • Assure appropriate fit
  • Avoid tight fit
Hernia belt
  • Available in different sizes
  • Peristomal hernias
  • Cautious use with convexity
Deodorant
  • Gels
  • Liquids
  • Reduces odour of stools in the pouch
  • Deodorizes straight drainage systems (fecal and urine)
  • These products are for pouch use ONLY
Stoma protectors  
  • Contact sports
  • Hazardous working conditions