Non-pouching techniques in the Neonatal Intensive Care Unit

Problem: The goals of ostomy pouching systems are to prevent stool or urine from reaching the skin and causing breakdown. For the premature ostomy population the adhesives are designed to be gentle and allow for ease in removal, ultimately providing optimal skin care. 

This dynamic can create a challenge with infant pouching where an adhesive may not withstand the effluent allowing corrosive stool to breakdown delicate skin.  Once the skin denudes the pouching can become more of a challenge as wet skin does not retain a pouch adhesive as long as dry intact skin.

Project Object: The goal was to create a non-pouching procedure to be used short term or instead of an ostomy pouch to protect the skin until the skin would heal, a more appropriate pouch could be found or until surgical stomal reversal. 

Methods: These cases focused on premature infant patients that could not have an appropriate ostomy pouch maintained greater than four hours leading to peristomal denudement or dermatitis. Patients were included if non-mobile, using only as a temporary solution or if surgery intervention was within a two week time frame.  Pouch was removed and left off, peristomal skin was coated with hydrocolloid paste and a levafiber hydroconductive dressing was used to maintain the stool away from the skin. A diaper was used to collect stool.  Holding feeds was preferred to decrease output until wounds healed, however, this was not a deciding factor to stop pouching.

Outcome: In all cases patient denudement was eliminate and open wounds were resolved.  Hydrocolloid paste protected the skin and the levafiber dressing maintained the stool off the skin.  Mild dermatitis was not at all times eliminated, but decreased overtime.