EP982 - Ostomy care: Two piece system

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Purpose/Background: This medical device being using for a long time, it needs modification, innovative technical upgrade for functional purpose, utility and safety in use.There was a proposal for, a) appliance leakage, b) skin complications, c) difficulties in removing the pouch and d) ill-fitting pouch. All the proposals were evaluated, modified, technical up-gradation and quality improvement was done.

Methods/Interventions: The Wafer is circular or rectangular in shape is soft with high quality adhesive that fixed with skin firmly. The wafer is designated by wafer rim diameter as 45mm for small intestinal stoma and 57mm for large intestinal stoma. The rim of the wafer should be soft enough to mould and can resist displacement and break down during movement and strain. The wafer outside and inside part of rim is similarly soft. The soft jelly bag which is a thin bag attached with back of wafer from wafer rim to margin of the central opening. After that the part of the bag is free that contains air or thin fluid and make an elevation 3mm to 5mm that protrude towards the pouch mouth. It is called fish mouth opening. Central opening of wafer is fixed. The stoma is 40mm in small intestinal and 50mm in large intestine. The stoma made in the abdominal wall is circular, so the central opening should be circular unless it is impossible or unavoidable. Jelly bag that contains air or thin fluid have adhesive gum up to the central opening margin for adhesion with skin.

Results/Outcomes: The fixed central opening in the wafer that is equivalent to stoma in abdomen used in clinical practice.The preformed central opening is smooth, clean margin and fixed.The jelly bag which is a thin bag containing thin fluid or air are attached with the inside wafer and the free part protrudes through opening containing the fluid form the elevation of 3mm to 5mm forming fish mouth opening is regular in contour.This jelly bag is soft, flexible and compressible. This bag allow easy passage of intestinal contents to the collection bag without dissemination.This jelly bag with fish mouth projection prevents contamination of the wafer, skin and the wafer pouch junction.The fish mouth projection prevents the regurgitation of content from collection bag to wafer.

Conclusion/Discussion: The soft wafer with good adhesive, non allergic and skin friendly.The wafer rim is malleable and soft to tolerate the shearing force and elastic.The opening in the wafer is fixed as per the type of ostomy. This fixed opening minimizing the hazard of enlarging the central opening, technical fault and hazard in doing the job. The functional difficulties and hazard of doing irregular, ragged and inadequate opening are solved. It is a problem solving solution and satisfaction of the patient.The margin of central opening of wafer keep a constant pressure over the underlying jelly bag and fish mouth protrusion of jelly bag that prevent undue protrusion of the skin and stomal margin outside consequently it minimizes stomal herniation.The Jelly bag is attached with the wafer and comes out through the opening forming a fish mouth opening that is firmly attached with the skin as well form a fish mouth opening that gives a guide for the intestinal content to collect into the pouch bag. There is no possibility of spillage of the content in surrounding area to contaminate the wafer and wafer pouch junction or the underlying skin.The fish mouth devise prevent the regurgitation of collected bag content to stoma, so skin reaction is prevented.