What care and management should be provided to a patient on the 15th post-operative day following a triple tube ostomy?

Management on Post-Operative Day 15 Following Triple-Tube Ostomy

By day 15 post-operatively, you should transition from daily aseptic wound care to simple soap and water cleansing 1-2 times weekly, as the stoma tract is now fully formed and healed. 1

Wound Care Transition at Day 15

At 15 days post-operatively, the critical healing period has passed:

• Discontinue daily aseptic technique - The stoma tract formation is complete (normally takes 7-14 days), and the incision should be fully healed 2
• Switch to simple cleansing - Use soap and water of drinking quality to cleanse the exit site 1-2 times weekly 2, 1
• Reduce or eliminate dressings - Dressings can be reduced to once or twice weekly, or the site can be left open entirely 2
• Monitor for delayed healing - If the patient has impaired wound healing (malnutrition, ascites, corticosteroid use, diabetes, immunosuppression), tract formation may be delayed up to 14 days, requiring continued vigilance 2, 1

Ongoing Monitoring Requirements

Continue surveillance for complications that commonly present in this timeframe:

• Inspect peristomal skin for erythema, leakage, induration, or signs of infection 2, 1
• Assess for allergic reactions to the ostomy appliance (itching, redness matching the product shape) 2
• Watch for fungal infections presenting as itchy maculopapular rash with satellite borders from prolonged moisture 2
• Evaluate stoma viability - Check for purple/black discoloration indicating ischemia, which requires emergency intervention 2

Appliance Management

Proper pouching technique becomes critical at this stage:

• Ensure proper fit - Cut the appliance opening one-eighth inch larger than the stoma to prevent mucosal irritation while limiting skin exposure 1, 3
• Maintain seal integrity - Heat the appliance with a hair dryer before application and ensure peristomal skin is completely dry 1
• Address leakage immediately - Apply zinc oxide-based skin protectants, barrier films, or pastes if leakage occurs 1
• Consider convex appliances if standard pouching systems fail to maintain adequate seal 3

Patient Education and Activities

By day 15, patients should be transitioning to normal activities:

• Permit full water exposure - Showering, bathing, and swimming are allowed once the site is properly healed (approximately one week or more post-surgery) 1
• Reinforce self-care techniques - Ensure the patient can independently manage ostomy output and maintain pouching appliances 2
• Address psychological concerns - Continue support regarding fears of leakage, odor, disclosure, intimacy, and travel 2

Critical Pitfalls to Avoid

• Do not maintain excessive tension on external fixation plates, as this causes tissue ischemia and buried bumper syndrome; maintain 5mm free movement 1
• Never use occlusive dressings at this stage, as they trap moisture and cause maceration 2, 1
• Do not ignore persistent leakage, as it causes progressive skin damage and may eventually require surgical intervention 3

When to Escalate Care

Refer to a wound ostomy and continence (WOC) specialist or surgeon if:

• Persistent leakage despite optimal appliance management 3
• Peristomal skin breakdown not improving after 2 weeks of conservative management 2
• Signs of stomal ischemia (purple/black discoloration, pain, obstipation) requiring emergency surgery 2
• Painful ulcers with purple halo suggesting peristomal pyoderma gangrenosum, particularly in IBD patients 2