Journal of Community Nursing - page 76

76 JCN
2013,Vol 27, No 4
STOMA CARE
Swan (2010) noted that it is vital
that nurses support the family and/or
carers by helping them appreciate the
practicalities of stoma management
and the effects on body image.
Berry et al (2007) suggested that
the use of adhesive removers is one
way to ensure that this aspect of
the individual’s care is made easier,
reducing complications, such as pain.
BENEFITS OF SILICONE-BASED
ADHESIVE REMOVERS
Using a silicone-based adhesive
remover can help to avoid the
effects of skin stripping, as well as
maintaining the barrier function of
the peristomal skin (Cooper, 2010).
Silicone-based products have been
found to be inert and‘skin-friendly’
as well as drying without leaving any
residue (Cutting, 2006). They are also
reported to be pain-free, especially
when compared with alcohol-based
solutions (Rudoni, 2011). Silicone
breaks the bond between the flange
adhesive and the skin without
inflicting skin damage or leaving oily
residue. This makes reapplication of
subsequent stoma pouches easier.
In preparation for a service review
of a silicone-based adhesive remover
at St George’s Healthcare NHSTrust,
London (Rudoni, 2008), stoma care
clinicians attached a stoma pouch to
their own skin for a few hours. Some
removed the pouch without adhesive
remover, while others used a silicone-
based adhesive remover.Those that
did not use the adhesive remover
experienced reddened and irritated
skin after removal, illustrating the pain
and discomfort of repeated changes for
people with functioning stomas.
(Stephen-Haynes, 2008). Alcohol-
based adhesive removers can sting
the skin, but because Appeel is
silicone-based it is pain-free (Cooper,
2010) — it also uses healthcare grade
silicone for patient safety.
Appeel is available as a no sting
spray as well as a wipe (
Figures 1 and
2
), which is specifically designed to
remove stomal adhesives. The spray
is perfect for applying the product at
any angle around the stoma, while
the wipes remove adhesive build-up
without damaging the skin. A version
of the product that has been sterilised
by gamma irradiation (Appeel Sterile)
is available for wound care (see www.
clinimed.co.uk).
As Appeel dries quickly without
leaving any oily residue, the stoma
pouch can soon be re-applied again. It
is also suitable for sensitive and fragile
older skin — as well as reducing
the anxiety of anticipated pain and
discomfort in stoma pouch changes.
Cost-effectiveness
Skin breakdown in the peristomal
area often triggers referral to
specialists and GPs as general staff
may not be familiar with the correct
management of common peristomal
complications such as leakage,
maceration and skin stripping (Lynch
et al, 2008). These problems can incur
a much greater amount of clinician
time than would have been necessary
had the skin breakdown been
prevented in the first place.
Figure 2.
The Appeel no sting wipe.
‘Appeel is available as a no
sting spray as well as a wipe,
which is specifically designed
to remove stomal adhesives.’
The same review also supplied
stoma patients with a silicone-based
adhesive remover, before asking them
about their experiences of removing
their pouches. Of the 54 people who
replied, 91% found it easier to remove
their pouch using the silicone-based
adhesive remover and 93% thought it
should be offered to all patients with
a stoma (Rudoni, 2008).
In a study by Berry et al (2007),
a similar percentage of stoma care
nurses (96%; n=648) recommended
the use of a silicone-based adhesive
remover to change a stoma pouch.
These studies demonstrate that
skin stripping from pouch removal
can be uncomfortable or even
painful (Dykes et al, 2001), but by
using adhesive removers correctly,
complications can be avoided,
helping to maintain quality of life and
saving on healthcare costs.
APPEEL
Appeel (CliniMed, Buckinghamshire)
is a silcone-based adhesive remover,
which helps to remove stoma
pouches, alleviating the distressing
effects of skin stripping that can
be associated with this procedure
Figure 1.
The Appeel no sting spray.
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