How should I manage skin breakdown caused by cyanoacrylate (super‑glue) used to adhere a colostomy pouch, and what safe interim pouch‑attachment options can I use until proper ostomy supplies are obtained?

Management of Cyanoacrylate-Induced Peristomal Skin Breakdown

Stop all cyanoacrylate use immediately and transition to zinc oxide-based barrier products with proper ostomy supplies, as superglue causes direct chemical injury and prevents normal skin healing. 1

Immediate Cessation and Wound Assessment

• Remove any remaining cyanoacrylate residue using a silicone-based adhesive remover, which allows for rapid and painless removal without additional skin stripping. 2
• Inspect the peristomal skin for extent of breakdown, looking specifically for erythema, induration, purulent drainage, bleeding, and areas of denuded skin. 3, 4
• Assess the stoma itself for any mucosal damage from direct glue application, as cyanoacrylate can cause tissue necrosis. 3

Wound Care Protocol for Broken-Down Skin

Return to daily intensive wound care until the skin barrier is restored:

• Cleanse the peristomal area with mild soap and water of drinking quality (or 0.9% sodium chloride if available), avoiding harsh cleansers or hydrogen peroxide which further irritate damaged skin. 1, 3
• Thoroughly dry the skin completely after each cleansing before applying any products, as moisture prevents barrier adherence and promotes maceration. 1, 4
• Apply ostomy powder (absorbing agent) to any weeping or denuded areas first, then dust off excess. 1
• Apply zinc oxide-based barrier cream, paste, or film over the damaged skin to create a protective layer between broken skin and the ostomy appliance. 5, 1, 4
• For established skin damage with granulation tissue, consider topical silver nitrate or high-potency steroids in addition to barrier protection. 1

Proper Ostomy Appliance Application

Once proper supplies arrive:

• Cut the appliance opening one-eighth inch (3mm) larger than the stoma to prevent mucosal irritation while limiting skin exposure to effluent. 4
• Heat the appliance with a hair dryer before application to improve adhesion, ensuring the peristomal skin is completely dry. 4
• Use foam dressings rather than gauze around the stoma site if additional absorption is needed, as foam lifts drainage away from skin while gauze traps it and causes maceration. 5, 1, 3
• Apply skin sealant over the barrier product before placing the appliance for additional protection. 5

Safe Interim Solutions (If Supplies Delayed)

If proper ostomy supplies are still not available, use the following temporary measures:

• Apply zinc oxide diaper cream or petroleum jelly as a barrier to protect skin from effluent. 1
• Use waterproof medical tape or transparent film dressings to secure a makeshift collection system (clean plastic bag), changing frequently to prevent prolonged skin contact with output. 4
• Never use cyanoacrylate, household adhesives, or duct tape, as these cause chemical burns and prevent healing. 1

Monitoring and Escalation

• Inspect the site daily for signs of infection including increased erythema, purulent drainage, fever, or increased pain. 3, 4
• If fungal infection develops (itchy maculopapular rash with satellite borders), apply antifungal powder under the barrier product and seal with sealant. 5, 3
• Escalate to wound ostomy and continence (WOC) nurse or surgeon if skin breakdown worsens, infection develops, or healing does not progress within 1-2 weeks. 5, 6

Critical Pitfalls to Avoid

• Do not apply adhesive products directly to irritated or broken skin without protective barriers underneath, as this causes further tissue damage. 1
• Avoid using gauze directly against peristomal skin, as it increases maceration risk by trapping moisture. 5, 1
• Do not use occlusive dressings, as they trap moisture and worsen skin breakdown. 3, 4
• Never allow the patient to run out of supplies again—establish a standing order with the medical supplier and ensure the patient has a 2-week backup supply at all times. 5

Long-Term Prevention

• Preemptively order ostomy supplies with adequate lead time, maintaining at least a 2-week reserve. 5
• Educate the patient on proper appliance removal using silicone-based adhesive remover to prevent skin stripping. 2
• Consider modern breathable silicone technology appliances that manage moisture through transepidermal water loss rather than absorption, reducing risk of moisture-associated skin damage. 7
• Connect the patient with WOC nursing services for ongoing education and support, as this has been shown to decrease peristomal skin complications and improve quality of life. 5, 4, 6