Prescribing Ostomy Supplies: A Comprehensive Guide
For optimal patient outcomes, prescribe a complete ostomy system including a skin barrier/wafer, pouching system, and appropriate accessories based on the specific ostomy type (ileostomy or colostomy) and patient needs. 1
Basic Ostomy Supply Requirements
Core Components
- Skin barrier/wafer: Prescribe either:
- Moldable skin barriers (preferred for preventing skin complications) 2
- Pre-cut barriers (if stoma size is stable)
- Cut-to-fit barriers (for new or changing stomas)
- Collection pouch: Either one-piece or two-piece system
- Drainable pouches for ileostomies (require emptying 3-4 times daily)
- Closed-end pouches for colostomies (typically changed once daily)
Essential Accessories
- Barrier rings/strips: For filling uneven skin surfaces
- Skin sealant wipes/sprays: To protect peristomal skin
- Adhesive remover: To prevent skin stripping during appliance changes
- Ostomy belt: For additional security with convex appliances
Specific Recommendations by Ostomy Type
Ileostomy Supplies 1
- Pouching system: Drainable pouches with secure closures
- Skin barrier: Changed approximately every 4 days
- Convexity: Consider for flush stomas to prevent leakage
- Additional supplies:
- Barrier rings to prevent liquid effluent leakage
- Skin protective wipes/sprays (higher risk of skin irritation)
Colostomy Supplies 1
- Pouching system: Closed-end pouches (for formed stool)
- Skin barrier: Changed approximately every 6-7 days
- Less frequent need for skin protection products compared to ileostomies
Management of Common Complications
High Output Management Supplies 1, 3
For patients with output >1.5L/day:
- Antimotility medications: Loperamide 2-4mg before meals
- Bulking agents: Psyllium fiber, marshmallows
- Oral rehydration solution components:
- 1L water + 6 teaspoons glucose + 1 teaspoon salt + ½ teaspoon sodium bicarbonate
Peristomal Skin Protection 4, 5
- For irritated skin: Barrier powder + skin sealant
- For persistent dermatitis: Corticosteroid spray (apply to skin, let dry before appliance application)
- For leakage issues: Convex barriers, barrier rings, ostomy belt
Special Considerations
For New Ostomies
- Prescribe both pre-cut and cut-to-fit barriers as stoma size will change
- Include measuring guide for proper sizing
- Provide both regular and convex barriers until optimal fit is determined
For Challenging Cases
- Flush stomas: Convex barriers and ostomy belts
- Uneven peristomal surfaces: Barrier paste and rings
- Persistent leakage: Consider cardboard tube technique for application 6
Prescription Quantities
- Initial prescription (new ostomy):
- 10-20 pouches/month
- 10-20 skin barriers/month
- 1 box barrier rings/strips
- 1 bottle each: adhesive remover, skin sealant
- Maintenance prescription:
- Ileostomy: 15-20 pouches/month, 7-10 barriers/month
- Colostomy: 15-30 pouches/month, 4-5 barriers/month
Pitfalls to Avoid
- Inadequate supplies: Patients reusing disposable products increases infection risk
- Wrong barrier size: Measure stoma at each appliance change for first 8 weeks
- Ignoring body contours: Failure to prescribe convexity for flush stomas
- Overlooking accessories: Barrier rings and skin protection products are essential, not optional
- Neglecting education: Ensure patient has access to wound/ostomy nurse consultation
Remember that proper ostomy supplies are crucial for preventing complications like skin breakdown, leakage, and dehydration, which can significantly impact patient morbidity, mortality, and quality of life.