Platinum with Vitamin E

Patient Name: Beryl Astill

Nurse Name: Lynette Robson Rose

Patient Care Setting: Patient’s home address

Patient Overview: A 68 year- old lady was referred from Nottingham City Hospital in November 2016 for support with the management of her abdominal fistula, oesophagostomy and jejunostomy site, alongside the District Nursing Team. The main reason for her referral was to support the District Nursing Team with managing her leaking abdominal fistula and improve the condition of the surrounding skin. Her oesophagostomy site was being dressed using Ostoguard no sting barrier film and a SALTS drainable appliance, NDAS13. To help to assist the healing of the direct macerated skin around the oesophagostomy, I advised daily changes of the appliance. Hole size in the oesophagostomy appliance reduced from 25mm round to 20mm round to fit more snugly which should help to prevent the opening from becoming more macerated. December 2016, on removing the SALTS appliance, I noticed that the skin was pink but patient didn’t complain of irritation. Cavilon barrier film applied as patient reported it previously having a good effect on her jejunostomy site. On the 16th December, patient had developed red, blotchy, spotty skin under the appliance in the shape of the flange. Pelican118412 appliances provided to try out until further review a week later.

Problem: Oesophagostomy peristomal skin showed evidence of a sensitivity to the SALTS appliance. Her peristomal skin was very red, blotchy and itchy on removal covering the area of skin under the flange of the appliance.

Suspected Cause: After a discussion with the patient and her husband regarding the SALTS appliance with Aloe Vera, she stated that she has previously reacted to other skin care products which have Aloe Vera in the ingredients. She suffered with redness and itching with these products, as she did with the SALTS appliance.

Course of treatment: Initially I changed her over to a Pelican Platinum appliance and used a no sting barrier wipe. This stopped the redness and blotchy looking skin. It also calmed the itching but still required a no sting barrier film for continued comfort.

I asked the patient if she would be willing to try the Pelican appliance with added Vitamin E. Since using the product her skin has not felt sore or itchy. She has found the appliance very comfortable, also significantly reducing the amount of barrier wipe she uses.

Interventions/complications? No, the patient continues to use the product.

Outcome: What I noticed from the pictures is that there has been significantly less macerated and excoriated skin directly around the oesophagostomy site. The skin is healthy. Most importantly, she has found it very comfortable on her skin. The pictures taken and sent in really don’t do justice to the reported soothing effect the Vitamin E appliance had on her skin around the oesophagostomy. After only a week of wearing the appliance, her skin was noticeably less red, blotchy and more comfortable. The patient continues to wear the Vitamin E appliance without any reports of itching, soreness or other irritation. One week later, no complaints of itching or irritation to oesophagostomy site but still looking red and slightly blotchy also using Cavilon barrier film for protection.

Conclusions: The patient no longer uses a barrier wipe on a regular basis, just occasionally to protect the skin directly around the oesophagostomy where the direct surrounding skin is often moist. This reduction in accessory usage will significantly reduce the monthly cost of her prescription.

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