Outpatient follow – up discovery of stoma site recurrence. A case study

Ms Melanie Perez1, Anne Mamo1
1St. George Public Hospital, Hebersham, Australia

This case study involves discovering stoma site recurrence in patients being reviewed in the outpatient setting. The aim is to show the importance of follow- up review in identifying unusual growth and nodules around the stoma. Routine follow- up involves the assessment of the stoma which provides the opportunity to detect minor changes that is potentially indicative of sinister occurrence. In order determine and classify the unusual growth, direct referral to the treating surgeon is essential for a definitive diagnosis. Hence, this paper also highlights the significance of collaboration and teamwork with the surgeon in providing timely intervention and management. As timely intervention and management of stoma recurrence is crucial as it directly impacts the pouching, the output, prognosis and the quality of life of the patient.


Biography:

I am currently working  as a Clinical Nurse Specialist in the Stomal Therapy department at St. George Public Hospital. I also work as a part- time Registered Nurse in the gastro, liver, peritonectomy surgical ward. Working as a Stomal therapy nurse and a ward nurse has given me the opportunity to appreciate the different challenges that comes from the ward and the stomal therapy department. The uniqueness and complexities of every case I encounter inspires me to be innovative, patient- centered and focus on improving patient care and experience.

The use of Negative Pressure Wound Therapy on the perineal incision following an abdominoperineal resection.  Can time to wound healing be reduced?

Mrs Trish Doherty1, Dr Kim-Chi Phan-Thien2
1Hurstville Private Hospital, Hurstville, Australia, 2Sydney Colorectal Associates, Hurstville, Australia

Background: Complications with the healing of perineal wounds following abdominoperineal resection are common.₁ These include infection, dehiscence, perineal sinuses, and abscesses.₁  Negative pressure wound therapy (NPWT) is a  treatment used to increase blood flow to the wound, encourage the development of granulation tissue, control exudate and decrease the amount of oedema in the area.₂  The use of a NPWT device on an incision can improve healing, decrease wound dehiscence and prevent infections.₁

Aims: The aim of this audit was to determine if the use of a NPWT device on the perineal incision site, as prophylactic wound management,  reduced the time to wound healing in patients following abdominoperineal resection.

Methods: This is a retrospective review of patients who underwent abdominoperineal resections. The medical records of patients who had negative pressure wound therapy applied to the perineal wound were assessed and compared to patients who had standard dressings applied in the postoperative periods.

Results: There were no differences in BMI, comorbidities, adjuvant therapy in those who did or did not have NPWT applied. Preliminary results show that healing time in the patients who had the NPWT applied had an average healing time of 25.25 days, compared to those with a standard dressing, average healing time of 82.71 days (p=0.118).

Conclusion: Our early data show no significant difference in the time to healing with and without NPWT. These data are limited by the small number and should be interpreted with caution. Further data will be collected and the results will be updated.


Biography:

Trish Doherty is a Clinical Nurse Specialist in stomal therapy, continence and wound care with extensive experience in a large tertiary teaching hospital as well as a smaller but busy colorectal surgical hospital in Sydney. Her current role involves working closely with a team of colorectal surgeons in their rooms and also in the hospital. This unique situation allows for continuity of care for colorectal / stoma patients from diagnosis to community follow-up.  Trish also works one day per week in the anorectal physiology laboratory which has given her knowledge in the management of functional bowel disorders, antegrade colonic irrigation and sacral nerve neuromodulation.

Trish has an enormous passion for stomal therapy, wound and continence care and is keen to develop her research skills in these areas.

Management of a growing Desmoid tumour in the setting of familial adenomatous polyposis with an existing ileostomy and active fistula in a nursing home setting

Mrs Rebecca Hook1, Ms Kirralee Foster
1University Hospital Geelong, Geelong West, Australia

We will follow the journey of 49 year old Mrs K who has a history of Familial adenomatous Polyposis.  This condition has subsequently resulted in a rapidly changing desmoid tumour.

The tumour was intially internal and has since become external.

She has an existing ileostomy and faecal fistula resulting in issues with the management of faecal output from both the fistula and the ileostomy. She resides in a nursing home and relies on nursing staff for all pouch changes and on going care.

Management was initially achieved with the use of small coloplast wound pouches but as the tumour grew and changed over the following 18 months, the use of various sized Eakin wound pouches were required to achieve some degree of tumour, fistula and stoma management due to the close proximity of all of the above. The tumour size has varied from 8cm x 8 cm to 36cm x 34cm.

Palliative care are involved with ongoing care, however with an unknown disease progression, and the nature of the ever changing tumour size,  stomal therapy involvement continues to be intermittent but ongoing.


Biography:

Rebecca has been a qualified Stomal therapy Nurse for 10 years and has a background in colorectal nursing. She works 3 days a week in the Stomal Therapy department at University Hospital Geelong. Kirralee is a recently qualified Stomal therapy nurse and is the third member of the stomal therapy team in Geelong.  They look after over 120 new stomas per year.

Anorectal trauma associated with sodium phosphate enema leading to Fournier’s gangrene requiring extensive debridement and diverting colostomy

Ms Fiona (Lee) Gavegan1, MS Karen Shedden1, Ms Annelise Cocco1, Dr James W.T. Toh1
1Stoma Therapy, Department of Surgery, Westmead Hospital, Sydney, Australia,

Fournier’s gangrene is a devastating life-threatening condition which is poorly understood. In today’s context, the most common cause of Fournier’s gangrene is perianal abscess followed by urological source – often in elderly, immunocompromised or diabetic patients with significant co-morbidities. However, the first documented genitalia gangrene reported by Baurienne in 1764 described a 14-year old male was gored by an ox, and subsequent early case reports also documented necrotizing perineal sepsis in young healthy men associated with trauma. In this case series, we revisit perianal trauma as a cause for Fournier’s gangrene. More specifically, trauma from administration of phosphate enemas inadvertently leading to Fournier’s gangrene. Within the literature, there have been only a handful of small case series of rectal necrosis associated with phosphate enemas, and rare case reports of Fournier’s gangrene associated with phosphate enema administration. Here we present a 51 year old male who was not diabetic or immunocompromised, and an 84 year old male who was diabetic who developed Fournier’s gangrene after traumatic enema administration. Both patients required extensive debridement of the perineum and scrotum and a diverting colostomy. We review the symptoms, diagnosis, management and sequelae of phosphate enema induced Fournier’s gangrene.


Biography:

Lee Gavegan and Karen Shedden are senior stomal therapists at Westmead Hospital, Sydney, Australia. Dr Annelise Cocco is a senior registrar at Westmead Hospital. Dr James W. T. Toh is a colorectal surgeon at Westmead Hospital and Clinical Senior Lecturer, Westmead Campus, The University of Sydney.

Necrotising soft tissue infection and management of a stoma after extensive abdominal wall soft tissue loss

Ms Colleen Mendes1
1Royal Prince Alfred Hospital, Camperdown, Australia

Background: Extensive loss of abdominal wall soft tissue creates a complex and challenging situation where a stoma is formed in the absence of abdominal wall skin or subcutaneous tissue.  This case study describes a 64 year old male who was admitted  in acute septic shock with a perineal mass and necrotising soft tissue infection extending over the abdominal wall. He underwent surgical debridement of the affected tissue, perineal proctectomy with wide excision of the anal sphincter and formation of colostomy.

Aim: The aim of this presentation is to describe a technique for isolation of a stoma that has been formed onto abdominal wall fascia, surrounded by negative pressure wound therapy dressing.

Method: The fascia surrounding the stoma was covered with a silicone dressing and a mouldable seal before a fistula isolation device was applied. The negative pressure dressing foam was cut to fit between the two bridges of the fistula isolation device. The abdominal defect was covered with foam dressing. With the negative pressure applied, the consitina in the fistula isolation device contracted down around the stoma and a bag was able to be applied.

Conclusion: The use of the fistula isolation device successfully separated the newly formed stoma from the negative pressure dressing allowing stoma maturation, complex abdominal wound management and avoidance of enteric contamination of the wound.


Biography:

Colleen Mendes is a Clinical Nurse Consultant in Stomal therapy at Royal Prince Alfred Hospital, Sydney, She has a 25 year nursing career, with 10 years specialising in this field. Colleen has extensive experience in stoma, wound, continence, antigrade colonic irrigation, sacral nerve neuromodulation programming and anorectal physiology.

Connecting through telehealth

Miss Jenny O’Donnell1, Miss Karen Cole1
1John Hunter Hospital, New Lambton Heights, Australia

Connecting via smart phones/ tablets and computers using Facetime or Skype has become the norm in the 21st century but does it have a role in Stomal Therapy? This is the question we have asked ourselves at John Hunter Hospital. John Hunter Hospital (JHH) is the major retrieval hospital in Hunter New England Local Health District. The district is a mix of a major metropolitan centre (JHH), several large regional centres and many small rural centres and remote communities within its borders. The district covers an area of 131,785 square kilometres- the size of England. The Stomal Therapy role is a 1.2 jobshare position and due to the workload we only see patients with stomas and fistula. Last year our surgeons created approximately 165 new stomas. Earlier this year, due to increase pressure for rooms in Surgical Outpatients our clinic hours were cut to 3 mornings a week. The decreased clinic hours and increasing patient numbers forced us to question “How can we improve the connection between the ostomy patient and STN?” Keeping in line with the HNELHD Strategic plan to improve equity of access and service delivery, telehealth was thought to be an obvious option. This presentation is about our journey using Telehealth, a secure transmission by videoconference over the internet. Included in this presentation are mindsets that had to change, what worked and what didn’t work, what questions to ask, patient feedback and future plans.


Biography:

Jenny O’Donnell has been relieving in Stomal Therapy since completing Stomal Therapy Certificate in 1985 and has been in her present CNC position for over 15 years. She was a member of the first AASTN Team of the inaugural Enterostomal Therapy Nurses Education Program (ETNEP) in Kenya. Jenny has presented at various conferences and study days.

Karen Cole is a registered nurse with 29 years’ experience. She completed her Stomal therapy certificate in 2000. Karen has been relieving in the jobshare position of Stomal Therapist for the past 18 years and is a committee member of NSW branch AASTN.

The impact of stomal therapy nurse clinics on appliance usage

Dr Vicki Patton1, Mrs Elizabeth English
1Sir Charles Gairdner Hospital, Hillarys , Australia

Aims: To assess the impact of the stomal therapy nurse visit on stoma appliance useage

Methods: Australian ostomates are very fortunate to have access to the Australian appliance scheme.

Patients were approached when they attended the stomal therapy clinic for follow-up or ostomy association for supplies. Patients were asked to complete a survey to elicit appliance usage before and after stomal therapy nurse consultations.

Results: Descriptive statistics and thematic analysis were used to analyse the results, which will be presented.

Discussion: There is a paucity of data around how the stomal therapy nurse clinics impact on the ostomate’s usage of appliances.  This study should give some insight into the economic effect of these clinics in relation reducing the cost burden to the appliance scheme.


Biography:

Elizabeth English has retired from the Royal Adelaide Hospital after 34 years as a Stomal Therapy Nurse and is now working in the Ileostomy Association of SA Stoma Clinic.  She continues as Team Leader for the WCET AASTN Australia: Kenya Twinning Project and is currently involved with developing Stomal Therapy Nursing in Mauritius.

 

Enhancing quality of life with a 2 – piece appliance: A series of case studies

Mrs Sarah Haughey1
1TG Eakin, Comber, United Kingdom

Enhancing quality of life with a 2 – piece appliance: a series of case studies.

Choosing the correct appliance is essential for enhancing a person’s quality of life. The journey of living with a stoma is not always straightforward and a person’s needs can alter for many reasons. Actual or potential stoma problems, (long term or short term), will cause a person to look for an alternative appliance to help them mange their stoma more effectively.

This presentation will look at 3 real life scenarios where the Eakin Dot 2 – piece appliance has proven to be the product which prevented potential problems from occurring, or solved problems experienced using an alternative product.

The three scenarios are:

  1. Peristomal skin problems
  2. A carers perspective
  3. Managing a stoma with a long-term health condition – Parkinson’s disease

The presentation will highlight 3 features of the Eakin Dot 2 piece which meets the needs of both nurse and patient.

Learning objectives:

  1. To create an awareness of a new product with a skin smart hydrocolloid and the benefits offered by this skin barrier.
  2. To create an awareness of the relationship between effective stoma management and improved quality of life.

Biography:

Prior to joining TG Eakin as Clinical Advisor in 2015, Sarah was the lead the Stoma Care Nurse in the Belfast Trust Northern Ireland. Her role extends across all departments within TG Eakin. She works closely with R&D from the concept stage of product development through the trialling and testing during the user study stage.  Sarah provides the clinical evidence behind the usage of all products.Sarah has a keen interest in developing the knowledge base of both stoma nurse specialists and those nurses who support the specialist nurses in delivering expert care to this group of patients.

Enhancing care using digital technology.

Mrs Sarah Haughey1
1TG Eakin, Comber, United Kingdom

Enhancing Care Using Digital Technology.

The world of healthcare is changing, and the impact of the digital revolution is changing how we as health professionals and users of these services receive information and communicate with each other.

We can receive a text message or email for reminder to attend appointments. Telemedicine is contributing to patient focused care where access to services is limited.

The use of digital technology is useful in everyday life and in healthcare. Fitness and lifestyle apps are used daily by millions of people worldwide. People with various health conditions can monitor their progress and record information for a review appointment.

Social media forums are growing with many offering support and advice but are often not clinically led or moderated. This can lead to the sharing of incorrect or inappropriate advice.

Could a digital community dedicated to the stoma care journey, help to support and empower patients to manage their own condition better?

Enhanced recovery offers benefits and challenges, an evidence based digital resource could enhance the benefits and reduce the challenges by helping the patient become an equal partner in their care.

This oral presentation will show how a digital approach to stoma education on a variety of platforms will complement the teaching provided by the nurse. This will be provided by offering up to date clinically evidenced information before surgery, during the in-patient stay and on discharge. The aim will be to support and encourage the person to manage their stoma in a confident, competent manner.


Biography:

Prior to joining TG Eakin as Clinical Advisor in 2015, Sarah was the lead the Stoma Care Nurse in the Belfast Trust Northern Ireland. Her role extends across all departments within TG Eakin. She works closely with the marketing team to provide expert clinical opinion for all digital applications.Sarah has a keen interest in developing the knowledge base of both stoma nurse specialists and those nurses who support the specialist nurses in delivering expert care to this group of patients. Part of this is helping to create material which helps inform the patients at all stages of their stoma journey.

Evolution of stoma accessories – customised stoma seals using individualised bioengineered 3D modelling technology

Mrs Wendy McNamara1, Dr David Morrison1
1Royal Perth Hospital, Perth, Australia

There is a significant cohort of patients who require the use of paste to fill deficits or creases in their peristomal skin prior to applying their pouching system. For some patients the use of paste can be messy, painful and time consuming. The use of a re-usable individualised silicone device fitting into the crevice or skin fold near the stoma is a new and novel solution. In turn it is hoped to increase wear time of the stoma pouching system, improve quality of life and decrease the financial burden on the Stoma Appliance Scheme.

Royal Perth Hospital Stomal Therapy Service in partnership with the Bioengineering Department has been developing customised silicone stoma seals. The seals are re-usable and are used in conjunction with conventional pouching systems. The seals are designed to fill skin folds or creases that may otherwise contribute to leakage, appliance failure and peristomal skin complications.

Bioengineering undertake a 3D scan of the patient’s abdominal topography in a seated upright position to demonstrate all folds and creases. From this, a reverse mould is 3D printed and an individualised silicone seal manufactured. The Stomal Therapy Service educates the patient on the correct application. A comprehensive evaluation of the device is also being undertaken.  This is proving to be an easier and cost effective solution to potentially complex clinical situations.

Implications for practice within the Stomal Therapy Nursing community could be immense given the cost of service delivery both to an individual, quality of life, health services and the environment.


Biography:

Wendy McNamara is the Clinical Nurse Consultant for the Stomal Therapy Service at Royal Perth Hospital. She has post-graduate qualifications in stomal therapy and continence and completed her Master’s in Clinical Nursing in 2016. She is involved in research at Royal Perth Hospital and is currently undertaking her PhD at Curtin University. Wendy sits on the Stoma Product Appliance Panel, is president of the WA Branch of the AASTN and in her spare time volunteers at the Western Australian Ostomy Association and loves spending time with her family and friends including 2 dogs, 1 cat and multiple fish.

1239

AASTN

This conference is proudly hosted by the Australian Association of Stomal Therapy Nurses: www.stomaltherapy.com

One of the Association's major objectives is the promotion of quality care for a wide range of people with specific needs. These needs may be related to ostomy construction, urinary or faecal incontinence, wounds with or without tube insertion and breast surgery.

Patients/clients across the life span are provided with preventative, acute, rehabilitative and continuing care as required. Another objective is the maintenance and improvement of professional standards in relation to Stomal Therapy Nursing Practice to the highest degree possible. Recognition of the need for and encouragement of the development of specialist expertise in the field of Stomal Therapy Nursing underpins the Standards for Stomal Therapy Nursing Practice.

Conference Managers

Please contact the team at Conference Design with any questions regarding the conference.
© 2015 - 2019 Conference Design Pty Ltd