Wound/Ostomy Care Tips

By: Angela Graham, CWOCN

 

“Do you have an Innie or an Outie?”  

 

No, I am not referring to belly buttons, but your patient’s stoma. This is a question I ask all staff who call me which is the same as what I assess when doing an Ostomy Consult. The height and location of the stoma will decide the best pouching system to implement.

 

If a stoma is flush/flat/or recessed = INNIE; you need to consider a convex pouching system and possibly a belt.

 

If stoma is budded/elevated/above skin level = OUTIE; the standard flat back wafers should work well.

 

Also Remember:

 

If you are making multiple PRN visits and/or a patient states they are changing their pouch more than 1-2 x week….then you need to contact me for an ostomy consult to help the patient /caregiver find the right pouch options.

 

Medicare allows 20 pouches per month. Patients typically will only use approximately 8 per month.

 

“Clean Technique Does Not Mean No Technique!”

 

In Home Care we perform Clean Technique wound care. We rarely are able to perform true Sterile Technique. What is Clean Technique?

 

  1. Meticulous Handwashing per our agency P & P

    • Use of soap/water when hands visibly soiled; after toileting or caring for current Clostridium difficule (C-diff).

    • Use of alcohol based hand gel otherwise between glove changes.

  2. Preparing and maintaining a clean field.

  3. The use of a MINIMUM of 3 pairs of gloves for each and every wound

    • First pair…take off dirty dressing

    • Second pair …clean wound

    • Third pair…..apply new clean dressing

  4. Use of sterile packaged supplies. Once opened, if using for more than one dressing,seal and store in the patient’s home to keep the materials clean.

 

As always, anytime you are performing wound care, assess the wound fully and if there are ANY changes that you question, whether the ICC WAT scores changes or not or the patient/caregiver questions, REPORT them to the MD and your Clinical Manager. It shows good faith, good customer service and responsible clinical care.