How do you protect a stoma during Padcev (enfortumab vedotin) chemotherapy?

Protecting a Stoma During Padcev (Enfortumab Vedotin) Chemotherapy

To protect a stoma during Padcev chemotherapy, use a zinc oxide-based skin protectant around the stoma site, apply a glycerin hydrogel or glycogel dressing, and ensure proper appliance fitting to prevent leakage. 1

Stoma Protection Strategies During Chemotherapy

Initial Assessment and Preparation

• Evaluate the stoma site for any existing irritation or damage before starting chemotherapy
• Ensure the stoma appliance fits properly with an opening cut one-eighth inch larger than the stoma to minimize skin exposure to effluent 1
• Check that the external fixation plate has very low traction without tension to prevent buried bumper syndrome 1

Skin Protection Measures

1. Primary protection methods:

   • Apply zinc oxide-based skin protectants to the peristomal area to protect from leakage and chemical irritation 1
   • Use a glycerin hydrogel or glycogel dressing as an alternative to classical aseptic wound care 1
   • Consider barrier films to create a protective layer between the skin and potential irritants 2

2. Advanced protection techniques:

   • For persistent irritation, apply a fine dusting of stomal powder followed by skin sealant on the peristomal skin 1
   • Use foam dressings rather than gauze to reduce local skin irritation (foam lifts drainage away from the skin) 1
   • Consider convex appliances, ostomy belts, paste, or barrier rings to bolster stoma height and prevent leakage 1

Appliance Management During Chemotherapy

• Empty the pouch more frequently during chemotherapy to reduce pressure and potential leakage
• Check appliance seal regularly, especially after episodes of chemotherapy-induced diarrhea
• Consider using a smaller or lower-profile pouch during treatment periods 3
• Ensure the peristomal skin is completely dry before applying a new appliance 1

Special Considerations for Chemotherapy-Related Complications

Managing Chemotherapy-Induced Diarrhea

• Patients receiving chemotherapy, particularly with loop ileostomies, may experience higher stoma complication scores 4
• Consider antidiarrheals to thicken stool and facilitate more solid effluent, reducing skin exposure 1
• For high ostomy output, proton pump inhibitors can be used to decrease leakage by minimizing gastric acid secretion 1

Addressing Skin Irritation

• Cleanse the stoma site with clean water and mild soap twice weekly 1
• Treat any fungal skin infections with topical antifungal agents 1
• For severe irritation, consider consulting with a wound/ostomy nurse specialist for assessment and treatment

Monitoring and Maintenance

Regular Assessment Schedule

• Measure stoma size at each appliance change for the first 8 weeks as size may change 1
• After initial healing (approximately one week), cleanse the site twice weekly with clean cloth using fresh tap water and soap 1
• Monitor for signs of leakage, which can cause significant excoriation from frequent appliance changes 1

Long-term Care

• Once the stoma site is well-healed, dressings can be reduced to once or twice a week 1
• For patients with gastrostomy tubes, ensure the tube is advanced into the stomach for a minimum of 2-3 cm 1
• Consider additional fixation or securement to minimize traction on the stoma site 1

Common Pitfalls and How to Avoid Them

• Pitfall: Excessive compression between internal and external fixation devices

  • Solution: Maintain proper spacing between bolsters, neither too loose nor too restrictive 1

• Pitfall: Improper appliance fitting leading to leakage

  • Solution: Ensure correct sizing and consider heating the appliance with a hair dryer before application for better adherence 1

• Pitfall: Neglecting early signs of skin irritation

  • Solution: Implement preventive measures early as the cost of treating peristomal skin breakdown can be high 5

• Pitfall: Inadequate protection during chemotherapy-induced symptoms

  • Solution: Increase monitoring and appliance changes during periods of increased output or diarrhea 4

By following these protective measures, patients can maintain stoma integrity during Padcev chemotherapy treatment, reducing the risk of complications and improving quality of life during treatment.