Stoma Care

 

 

 

 

stoma care - basics

 

STOMA CARE ADVICE

 

SALINE SOLUTION

1. Make your own by boiling one cup of water and adding 1/8 teaspoon of Kosher or canning salt. Table salt contains an anti-caking agent and Iodine, neither of which do you want in your lungs. Put it in a suitable closed container. If you don't use it within a week, toss it and make a fresh batch. Apply with an eye dropper, syringe or spray. This solution can be used for cleaning the stoma, irrigation of the stoma, and flushing out the nasal passages. Adding 1/8 teaspoon baking soda adjusts the pH balance of the solution. Use it warm and it is good for getting rid of sticky mucus. (Put together from suggestions sent to the WW list. The hint about the type of salt was sent in by Mark Finfrock)

2. A saline solution for irrigation is easy to make. To make an isotonic solution (one similar to the salt content of your bodily fluids), mix 1/4-teaspoon salt in an 8-ounce glass of warm water and add a pinch (1/4-tsp.) of baking soda. Discard any unused solution. You may chose to use filtered or distilled water if your water contains a lot of chemicals. Table salt can be used, but many prefer to use non-iodized canning or pickling salt. Using baking soda improves the mucus-solvent properties of the solution. Taken from http://allergies.about.com/library/weekly/aa040802a.htm

3. You can purchase sterile saline at your local pharmacy in large bottles to fill your own bottles or sprays. You can find it in small nasal spray bottles or in the contact lens care section of the store. Several manufacturers sell saline in a can for misting and you can purchase saline bullets. All of these things contain the same product.

4. I was in WalMart and discovered Wound Wash Saline. I went to another isle and found a can of Simply Saline and compared the two. They are both made from the same company, BLAIREX, and have the same exact contents. Simply Saline is 1.5 oz and Wound wash is 7.1 oz for $3.00; the only difference is the nozzle, it's not as fine as Simply Saline but it's a little more direct and a more powerful spray. I like it a lot better. The price is definitely right. http://www.woundwashsaline.com   Dennis D.

5. Sea water is 3.5% salt (I looked this up). Normal saline is .91%. When you swim in the ocean, yes, you'll get the salt residue on your skin as you dry but the inside of your body is normally a bit salty--more like normal saline. When you shed tears, they are salty. If you need to flush out your eyes for any reason, plain water will sting. If you use normal saline, this will not sting (at least not as much). In the hospital, when they give IV's, it is
usually normal saline that they give you to be close to the saltiness of your
blood. Saline was used to flush wounds--get rid of whatever debris.

I don't think plain water will do any damage to any of the mucous areas of our bodies, just may sting a bit. As to the stoma, I think the normal saline will not be as irritating as plain water (sterile, distilled, tap, whatever). And I THINK, since the stoma is more INSIDE your body, it would also fall under this normal saline area. I am not totally up on the above, but I did train as a nurse and worked many years as one.  Vicki Metz

6. Saljet small volume saline solution application licensed for wound care.

Packaged in four vials per strip, ten strips per carton, see video:

http://www.saljet.com/home.aspx

7. Pink Bullets! Normal saline solution dispenses by the drop in 3, 5, and 15 ml increments, or quickly for procedural efficiency in tracheal cleansing. 100 Per Box

8. Saline Solution is used for eye wash, nasal irrigation, and stoma irrigation. Look under Google for Saline Solution, In Amazon?  Find in Med supply places or our own vendors. Check your drug store and WalMart.. Read the labels and compare. Same or similar product, different packaging and pricing.

 

MOISTURE

You will breathe easier, cough out thinner mucus with less effort, and have a cleaner, healthier stoma if you will irrigate, use a humidifier, and keep your stoma covered to avoid losing moisture each time you exhale. If you are away from your humidifier, carry a small spray bottle with clean water and use it to spray your stoma and your stoma cover. Keeping this area moist is the secret to avoid any crusting (dried mucus in and around the stoma) and to keep any bits of dried mucus or blood from solidifying inside your trachea. If you are crusting or coughing up dried bits, add more moisture.
(Check our Stoma Dos and Don'ts for more hints on moisture or humidifying)

 

CATCH THE SNEEZE

When you cough or sneeze and don't get covered in time, the result can be embarrassing when projectile mucus flies from the stoma. Avoid this by using a stoma cover or at least something like a foam square. This will protect your clothing and keep foreign items, like a flying bug, from entering your stoma. In the unlikely event that this occurs, a little squirt of saline solution or plain water in the stoma will help to cough it out. (See Stoma Cover Section)

 


USE A GOOD STOMA FILTER

For laryngectomy patients, like myself, living on the Gulf Coast, low relative humidity is seldom a problem unless you happen to share air-conditioned office space with numerous electronic office automation devices. Facility managers tend to crank down ambient moisture to insure long life and proper function for these non-human contributors. In this situation and lacking a functioning nose and sinus passages, you will have an annoying little problem that will not effect your co-workers. Not only is your body tricked into believing you are working in Death Valley, but the lower humidity contributes to additional airborne particulate material. "Paperless office" is still very much an oxymoron and there is plenty of paper dust to take flight in the artificially dry air. The result – A significant increase in mucus production while you are at work. Not something you really need while trying to blend in. How do you remedy this discomfort when environmental changes are clearly beyond your span of control?    Simple – If you can't change your environment, you change yourself. First, super-hydrate by drinking more water than a fish. Forget trying to count and comply with the dumb eight glasses-a-day rule, just drink water until your urine begins to clear. To avoid constantly beating feet to the water fountain, keep a water jug and stadium cup at your desk. After a while, all this additional water intake merely becomes part of your daily routine. You may wish to cut out or at least cut back on coffee consumption. The only way to defeat airborne crud is to have very, very good stoma filtration. There are a number of fine products on the market, but at this point, my personal favorite is the PROVOX Stoma filter. When I discard a filter cassette, you would not believe what that little devil has intercepted for me. In addition to keeping bad stuff out, good filtration also slows the escape of moisture from your respiratory system. Everyone is different, but this should reduce your mucus production to manageable levels while you are at work and allow you to return to your former level of productivity. Unless you are looking for a reason, a laryngectomy should not force you into retirement. (Marvin Whitley)

 

THE TISSUE ISSUE


Puffs are available plain or with aloe cream in them and they seem to shed less than others. Some of the harder finish store brands also shed less. Try several brands and see what works best for you. An environmentally friendly solution to our need to catch a cough or to clean our stomas is to purchase a quantity of low lint cloth handkerchiefs or soft, thin, washcloths. Wash several times to get rid of the lint or dye odors before using.


See below for suggestions from our list:

(1) The only time I use Kleenex is when I am not glued up, and my stoma area is fairly clean (no glue residue); normally, I use a cotton handkerchief, with NO starch. I have used paper towels, toilet paper, catalog pages, old newspapers, and leaves, when in need. None of these do I recommend other than in an emergency. I think paper towels are too rough and like something that is soft, but that will not fall apart. That's why God invented cotton handkerchiefs.

(Philip Clemmons)

(2) After one of our returns from our friendly ENT, we had an abundance of NUGauze General-Use Sponges. They are made by Johnson & Johnson and are 4"X4" and 4 ply. They are available at any medical supply store and come in Qty. of 200. We use these exclusively for stoma care, wash them out with any anti bacterial soap and are reusable for sometimes up to a week. It's great because they are soft on my Hubby's skin and everyone knows how tender the area can get. They also don't create any residue or dust like tissue does.

(Maria--caregiver of William)

(3) I started out with one of the well known paper towel brands until they changed their consistency and were much coarser and not soft at all. Then, I then switched to Bounty Select-a-Size and have been using them for many years now with no problems.

(Jean & Donald Blaisdell)

(4) By now you should have figured out that the biggest part of getting on top of this laryngectomy thing is simply mucus management. That stuff just shouldn't be running down your neck/splattering your mirror or keeping you from enjoying a good breath of fresh air. The former is unsightly and the latter is downright uncomfortable. Most likely, the first thing your friendly ENT or nurse gave you to remedy this situation was a facial tissue and there is very good chance that your are still using them for that purpose. Wrong! Those things are designed for some lady to remove her facepaint or for you to blow your tender, sensitive, formally useful nose. Actually, you may encounter a couple of very real problems using facial tissues for stoma cleaning. First, they are just too light and flimsy making them a fair candidate for inadvertent aspiration. A damp tissue in the stoma? I doubt anyone would want to go there! If that were not bad enough, there is another, equally undesirable, reason for not using facial tissue. Go to a strongly sunlit window and shake your facial tissue. See that little dust-like stuff being ejected into the air by the tissue? Those things are tiny, irritating wood fibers. Every time you place a tissue near your stoma, you give your windpipe a good dose of that. Care to guess what they produce on the vulnerable mucous membranes of your respiratory system? You got it. More protective mucus! You may wish to consider using something a little more substantial like paper napkins or paper towels. I take my wife’s select-a size paper towels, cut them in half and keep about 50-75 in a square, 5 cup sized, Rubbermaid ® serving-saver container that seems to be designed for that very purpose. It doesn't matter what you use, but you really do need to put those facial tissues down.

(Marvin Whitley)

(5) My two cents worth goes as follows. You are all right and all wrong. I have used tissue, paper towels, wash cloths, handkerchiefs, napkins, and the same 4x4 gauze pads from the hospital. They all work just fine, as to how much lint is involved, I don't know. I have settled on the 4x4's and napkins, Yes plain ole dinner napkins. I feel very secure and safe using these. This brings me to my point, whatever makes you feel the best about yourself is what you should be using. There will never be a universal cure-all solution for all of us, so never be afraid to try something new, TRY them all and go with your heart.

(G.W. Buck--Fuzzy)

(6) I'm sure I'm going to get into trouble for this reply, but I think all the discussion about paper towels, gauze pads, wash cloths, handkerchiefs and tissues is a tempest in a teapot. Granted, we are all different – and certainly entitled to our own opinion - but I've been using Kleenex for over 15 years and I'm wiping up mucus for heaven's sake which should trap most, if not all, of the lint they generate. I've not had a mucus plug since three days after surgery and not had serious mucus problems since I was at the hospital while my wife was getting a new heart valve and I had a full blown case of bronchitis. I see some lint on my "hands free" filter at the end of the day, but have no idea if its source is Kleenex, cats, or house dust. I suspect that there's more incidental dust in our lives than from a tissue.

(Carl Strand '93)

(7) Never thought we'd be having an ongoing conversation about tissues and gauze pads, but it does help to fill up the time between bowl games. Gauze pads were never suggested, and I didn't want to start laundering handkerchiefs, so I've been using the maligned tissues for 10 years. I don't inhale because that would defeat the purpose, and when I exhale I do it rather forcefully so any lingering lint should be blasted into outer space. That's my theory and I'm stuck with it.

(Mike Rosenkranz ’99)

(8) I'm afraid of tissue also. But one thing I have not seen mentioned is the inexpensive wash cloths. The ones that you can buy a stack of them for 5 dollars. They are great around the house and just throw them in the washer/dryer.

(Linda Palucci)

(9) Here is another possible alternative to the tissue/paper towel issue. Someone had recommended to me that "Puffs" has much less lint than other tissues and a lot less irritating than paper towels. I have been using Puffs ever since. Puffs come in home/office size boxes as well as pocket size packages.

(Don Whipple-2000)

(10) On searching for as close to a lint free paper towel as I can find I came across a brand called So Dri made by Georgia-Pacific. These have much less lint than Bounty or any other brand I have tried. They are not as soft as some but I use them for cleaning my Lary tube and am not worried about them being "user friendly" but just want something that soaks up the water and leaves as close to a lint free surface as I can get, so these do the job just fine for me.

(Wild Bill from Minnesota)

(11) For all those messy mucus, and other messes that need swabbing near the stoma, I have been using cut pieces of Good Paper towel, Bounty mostly in select-a-size, (learned from WebW on one of it's helpful pages) but it takes time to cut them, and convenience is everything these days. I have found that Charmin makes an Extra Strong variety that is almost as lint free as the bounty, but not quite. But it separates into one two or three sheet amounts without cutting, and fast, and accurately. The size is perfect for me. Dust and lint being slight, I believe they are a good back-up, or primary swab to carry with, or have around the house. I stack them up and put them in plastic bags, or just a pocket, or tray.

(Steve Israel)

 

TEE SHIRTS

One of the most irritating, exasperating things about my stoma was when clothing like crew neck tee shirts blocked my stoma from time to time. V-neck tee shirts are a welcome relief and make it much easier to get to the stoma for cleaning.

SOFTEN DRIED MUCUS FIRST

I found out the hard way that you should first soften dried mucus which can accumulate around your stoma before trying to remove it with tweezers. You can really irritate your skin if you pull dried mucus from the stoma area without first softening and loosening it. If you shower or bathe in the morning, let the water vapor or steam soften dried mucus before removing it with your tweezers. Warm water on a dampened washcloth will also do the trick. For those who have the TEP prosthesis, the tweezers are also handy to use along with a tiny brush and modified hypodermic style syringe/pipet to keep the prosthesis clean.

ANOTHER WAY TO SOFTEN DRIED MUCUS

When you first get up in the morning wet your stoma bib. By the time you take a shower, that moisture will have softened the mucus you see, plus loosened some you couldn't see so you get a productive cough and start the day right. You may not need to use tweezers since thinned mucus coughs or wipes out

PICK UP MUCUS WITH TEP BRUSH

I'm sure everyone is familiar with trying to remove wet mucus from around or just inside the stoma, stuff that is not deep enough in the trachea to cough out. Tweezers are fine for dried gunk but, at least in my case, just pulls the wet stuff out in strings, it lets go and springs back. It's an unending chore. In the meantime I gurgle as I breath.

I take the TEP prosthesis brush and roll it around in the wet mucus. It winds up like spaghetti on a fork. Three or four windups and the mucus is gone. I rarely use the tweezers anymore. To make the twirling between my thumb and forefinger easier, I removed the handle from the end of the brush. Good luck, Bob Power

GUAIFENESIN

Used for keeping mucus thin.

From the Internet >>>Guaifenesin is an expectorant, a medication that promotes elimination of mucus from the lungs. The expectorant effects of guaifenesin promote elimination of mucus by thinning the mucus and lubricating the irritated respiratory tract. Guaifenesin is an ingredient in many over-the-counter cough and cold products. Guaifenesin was first approved by the FDA in 1952.<<<

Some laryngectomees take this on a regular basis and in varying amounts. Most everyone takes it when they have a "cold" in one cough syrup or another. Please take it with enough water to make it effective. It's purpose of liquefying mucus needs the water and you may find that less medication with water works better than a lot of medication without extra water.

Robitussin or Tussin (Most drugstore chains have their own brands, Read the label.), is a non-prescription liquid cough syrup and is 100mg guaifenesin per teaspoon. You want the one that is all guaifenesin, nothing else added. It should be marked something like Robitussin PLAIN, not the CF or DM which have other ingredients.

Humibid, Humibid LA, Fenesin and other prescription guaifenesin is in tablet forms. 200mg, 300mg and 600mg. See your doctor. If you can't swallow the large pills, and they have a 300mg capsule that can be opened and sprinkled...BUT I haven't been able to find it or order it, so I keep some Plain Robitussin liquid to use if I feel I need some help with thinning mucus. First, I try extra water alone. Surprising how much help that is and how seldom we think of it!   Pat Sanders

MORE GUAIFENESIN

Something that I do on occasion when I know that I will be in very dry air, i.e. airplane, long car ride, etc. I take Guaifenesin to help keep things lubricated and thin. It seems to work for me. This way I'm on top of things, a little preventive medication. Rita Burfitt

A WELL LIT MIRROR

Since all of us with stomas spend considerable time caring for and cleaning them, a well-lit magnifying mirror makes a difference. A makeup mirror with lights on the sides helps. So will a small lamp that aims a spot of bright light. Look in the catalogs with laryngectomee supplies.

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