Stoma Care

 

 

• Stoma Care - Basics
• Stoma Care - Do's & Don'ts
• Stoma Care - Equipment
• HME (Heat/Moisture Exchange)
• Stoma Covers and Patterns
• After Care - Mucus Problems

 

 

Stoma care do's & don'ts

 

 

DO - ADD HUMIDITY  (Hints from our members)

 

AFTER SURGERY

I had my surgery in February and was told to keep humidity high in the house. I was running 3 portable humidifiers, 24-7. The windows were soaked and the paint peeling off the walls under the windows. Result, I just spent a fortune to have damage repaired and the house painted. This year, I bought a small unit to measure humidity for $6 and keeping humidity to 50%. Seems to be working. I live in cold Canada, where it's about 5 Fahrenheit this morning.
Joe S. - Ontario

HOW TO HUMIDIFY

In my one-bedroom apartment I have a humidifier in the living room, another in my bedroom, and I keep a pot of water on low heat in my kitchen during the day, just to keep the place moist. I live right on Lake Erie but the winters tend to be dry and cold, and believe me, these help. Come summer, when the air conditioner is on, makes no sense for any of that: The AC has a de-humidifier built in and, with the Lake right outside, moisture a-plenty.
John S. - Ohio

HUMIDIFIERS

1] Wal-Mart has a good ultra-sonic that holds about a gallon and a half. The output is adjustable so you can add more or less as you need. Radio Shack has a Digital Thermo-Hygro gauge that tells you the temp and Humidity on the same face. It's battery powered and the batteries last a long time. I can't remember what I paid for the humidifier or the gauge but both were less than $50 together. I have had mine about 2 years and both work great.
Joe W. - FL

2] I recently purchased a Venta air washer and humidifier. We got the 360 sq ft model LW24 to run in the bedroom. It works great and it also cleans the air. We don't have an instrument to measure the amount of humidity in the room, but my husband has no problems with excess mucus or crusting. We live in Florida where the humidity is generally pretty high except in winter. We have no problems with humidity/moisture build up in the room. PLUS it is very quiet. You won't notice it is even on. The nice thing about the Venta is you don't have any filters to replace and it is also almost maintenance free. Every 10-14 days, rinse off the barrel and add some cleaning solution (sold by Venta) that keeps everything clean and mold/mildew free. We add about 1/2 to 1 gallon of water every day (depending on how long we run it). They are not cheap. I think we paid about $300. We are now considering purchasing the larger model that will wash and humidify up to 760 sq ft to put in our living/kitchen area. Their website is http://www.venta-airwasher.com/. I purchased mine from Bed Bath and Beyond.
Debbie W. - FL 0207

3] I am 3 yrs. out of surgery, and I have always had a problem with my stoma bleeding during the winter months when I have to use my central heat, and summer months when I use my air conditioner. The culprit, I have found, is humidity, or the lack of it. It is my experience that trying to humidify an entire house is really a chore, not to mention expensive. Instead, I use a personal heat and humidity system. I have the DeVilbiss 8650D aerosol compressor with a trach mask that I sleep with directly over my stoma. The drawback to this setup is the noise the compressor makes. It's not as noisy as a large compressor, but it does put out a pretty good hummmmmm. But then, you don't have to use it at night. You can use it during the day while you are relaxing, watching TV, or whatever. Being an old Vietnam Vet, I can sleep through a nuclear attack if I choose to, so the noise doesn't bother me at all.

If you've never seen this setup, it's a small air compressor with a heated nebulizer bottle attached that you fill with distilled water. Attached to this is a 4 or 5 ft. length of corrugated tubing with a trach mask on the end. The trach mask goes directly over your stoma with an elastic strap around your neck to hold it in place, and the compressor blows a very light stream of moist, heated air which you breathe. You can do this for any length of time you choose. I personally use mine at night for 7 or 8 hours. When I make my run to the bathroom I refill my water bottle This has completely eliminated my stoma bleeding problem. Sometimes I go days without using it, when I notice a little blood in my mucous I know it's time to spend a couple nights on my humidifier.

I don't have a clue to the price of this humidifier, being that it is supplied by the VA. The best I could come up with is an address for the manufacturer:
Sunrise Medical
100 DeVilbiss Dr.
Somerset, Pa. 15501-2125

Of course you will want to see your ENT doctor first to make sure your bleeding isn't being caused by something else.
Robert P. - GA 0106

4] I have been told the "wicking" type is the most effective and have several of them. They have a large filter in them which the water is pumped over the top and down a sort of channel that causes a waterfall over the top of the filter keeping it constantly wet and the fan blows through the filter evaporating the water. The brand I use is Lasco as it is common in my area and filters and such are readily available. It has a 3 speed fan and a humidistat adjustment on it so you can set it to go on and off when you reach a satisfactory level of humidity and it will maintain this degree of humidity automatically. Mine is a Lasco model 1128 9 gallon recirculating humidifier. It holds about 4 gallons of water and is rated at 9 gallon discharge per 24 hours. I think the cost on this was about $60.00, and I use just this one unit in a very large 9 room old farm house built in 1864. I change my filter yearly unless I have a lot of mineral deposits that don't clean off then maybe twice a year. I live in the country with my own well and, even with a water conditioner, we have a lot of minerals in our water. But rather than used distilled water I just use a humidifier water conditioner. It cost about $2.00 per quart and mixes @ 1 tablespoon per 1 and 1/2 gallon of water for my situation anyway. I take my filter out usually every two weeks and soak it in warm water then rinse it several times and this removes all the mineral deposits. The most important thing I have found is to make sure you have a humidistat gauge before you start messing with the humidity in your home. If you don't know what the current humidity is, it will be impossible to adjust it so you are comfortable. You can purchase these for anywhere from $7.00 to $15.00 in my area anyway. Wal-Mart carries them around here and I keep one on each level of my house, one in both my offices and one in my vehicle when I travel on trips as the A/C removes humidity and by shutting it off for several minutes you can bring the level back up again. I have found that every year since my lary operation I tolerate a little less humidity then I did the previous year. I think our bodies tend to adjust to some of our adverse conditions over time.
Wild Bill from MN 1206

HYGROMETER

A hygrometer will keep track of the humidity. You should try to maintain it in the 40% to 50% range, although a little less may not be a problem IF it doesn't cause excess mucus and coughing. I have a Vicks that cost about $35 or $40 and, on low, I can hardly hear it with it placed within six feet of me.
Dave R. - FL 0807

PERCENTAGES

I live in Minnesota and have found anything over 30% humidity is within my comfort zone. I only use a humidifier during the winter months. I keep it in the 30 something % range on my homes main floor which results in the 40 something % range on the second floor where my bedroom is located. Theoretically my attic will be in the 50 something % range as the moisture seems to rise. This should keep any mold from forming in my attic as that is supposed to happen around 60 - 65%. I have a humidifier in my office that I use during the day. I have several gauges in my home so I can monitor the % and adjust as necessary.
Wild Bill, - MN

HUMIDITY - INTERNAL & EXTERNAL

I would hate have beat the big "C", for as long as I have, then die from coughing. The ideal objective for lary mucus is to have a continuous flow of watery, almost clear mucus. Like mucus elsewhere in your body, that which is produced in the respiratory system protects the tissues of the trachea (stoma hole and tube down to the lungs) and lungs which are exposed to the dirtier, colder, and drier air (since the upper part of our respiratory system became bypassed by the laryngectomy surgery.) In addition to providing a protection of the tissues to prevent drying and the invasion of bacteria and viruses, the upward mobility of the mucus carries any impurities which are breathed in up so we can cough them out. Managing the amount of mucus used to be an automatic process before we became larys, but now we must play a more active part. Things we have to actively do to get and maintain a good consistency and flow of mucus (basic):

1. Hydrate yourself. Do not just drink water when you are thirsty, but drink enough water and other liquids during the day because water from your body is the building material for the formation of protective mucus.
2. Keep the humidity in the spaces you control at about 50% relative humidity (certainly no higher than 55%). If you have an automatic whole house humidifier, your job is easy. You just set the humidity level like you set the temperature with your thermostat. The rest of us have portable humidifiers and humidity gauges to check it. You can buy portable humidifiers which have an automatic on and off function when they reach the set humidity, but they are not inexpensive.
3. Wearing an HME (Heat/Moisture Exchange) filter raises the humidity and heat of the air you breathe by temporarily storing both in the filter when you exhale, and returning it to the lungs when you inhale again. The filters are also excellent at filtering out the impurities found in the air around us we breathe.
4. While we disagree about whether it should be a daily ritual or only used occasionally or as used, squirting some sterile saline into your stomas can help loosen by thick mucus and help you cough it up. A product like Simple Saline or the pink saline bullets serve this purpose.
5. You can also add additional humidity at the stoma level by dampening a cloth (the double lined ones like the Gennel are particularly good) or foam stoma patch. When you travel in your car, or otherwise, you can carry a small spray bottle containing water to redampen your stoma cover. Whenever I fly, I bring or ask for a bottle of water and use that to keep the stoma cover wet. Doing so also improves the covers ability to filter impurities from the air.
6. You can also get some temporary relief from dryness when you take a steamy shower, breathe in the steam from a boiling teapot (don't get close enough to get burned), or use a nebulizer.
David B. - VA

USE BULLETS

I always carry at least one saline 5 ml capsule in my pocket. When I start repeated coughing, I squirt 1/2 or all of it into my stoma. This seems to replenish the moisture in my lungs and the coughing stops. I keep these capsules in my jacket pockets, car glove compartments, my desk drawers at work and always one in my shirt pocket so they are always handy when I need them. I also start and end my days with 1/2 a capsule. I use 1/2 the capsule in the morning and the other 1/2 at night. These can be purchased without a prescription now due to some change in a Federal law. Wal-Mart and Target both carry them in the pharmacy and they are about $14.00 per box of 100 which to me makes them more cost effective than trying to mix up and package your own saline and the plastic container is also recyclable.
William C. - MN

MOTHER NATURE USUALLY GETS THINGS RIGHT

Prior to the laryngectomy surgery the air which reached our lungs was almost always filtered completely clean, was 98.6 degrees Fahrenheit, and 100% relative humidity (think fog). The laryngectomy surgery bypassed the upper part of the airway which accomplished this conditioning of our incoming air and what we began to breath was dirtier, cooler, and drier. Too little humidity is unhealthy, as is too much. At either extreme the environment is ideal for the growth of respiratory infections, bacteria, dust mites, fungi, viruses and the like. There is an article on the ideal humidity levels for larys in this issue of the WW monthly publication:http://www.webwhispers.org/news/dec2000.htm We can adjust to dirtier, cooler and drier air, but if you believe that Mother Nature tends to get things right, doing what we can to approximate our respiratory environment prior to becoming larys seems like the better idea.
David B. - VA

TOO MUCH OF A GOOD THING

Too much of a good thing? 50% relative humidity is about the maximum before the disadvantages overwhelm the advantages of additional humidity. There is an article, "Ideal Humidity Level," with a chart which shows why too dry air or too wet is not healthy in this issue of the WW monthly publication: http://www.webwhispers.org/news/dec2000.htm As you mentioned, an excellent investment is a digital battery powered humidity gauge (hygrometer) (great holiday gift for a lary!) available from Wal-Mart for under $10. However, during the winter months I find that I still must add more humidity at the stoma level by dampening my stoma cover with water or I will still dry out. It is less of a problem in the summer months.
David B. - VA

HOME-MADE SALINE

Make your own saline solution by adding 1/4 teaspoon of Kosher salt to one cup of boiling distilled water. I used this solution after surgery & still do, about once a week. I keep a nasal spray bottle with me at all times to mist my stoma when dry. My stoma stays spotless & I have very little coughing problems day or night.
Harvey G. - TN

QUIET AIR COMPRESSOR/HUMIDIFIER

I am 5 years post surgery and I have found MY solution to the humidifier vs noisy machine of the usual nebulizer. I was using a monster that seemed like it weighed 25 or 30 lbs and sounded like a jack hammer. I tried connecting a long hose and would leave it sitting in the hall outside my bedroom. The major problem is the long hose would sag and moisture would condense and accumulate as water in the lowest point of the hose. Then with water accumulating in the hose it would start "gurgling".

My wife travels quite a bit on her job and, since I'm retired, I like to accompany her as often as I can. Also, we both like to travel internationally as often as possible. Travel was a real problem with the overweight, noisy monster, so I started looking for an alternative. There was a person discussing this very topic on this Web Site about 3 years ago. When I checked this persons recommendation out, I found it worked for me. This person recommended purchasing a CPAP Model 200 which is a humidifier producing low humidity and very low noise and weighs about 14lbs. It produces air and humidity through a hose with the stoma mask. The noise level is similar to what a fan will make with no machine noise and only air movement noise. There may be two drawbacks to purchasing one of these units and those are the price which is about $450 to $500 and, secondly, the unit produces a very low humidity output, which may not be enough for everyone.

On the up-side, because of the light weight, it can be transported easily and it is small enough to fit in a carry-on bag for airline use. Another plus is that cleaning is simple with no fear of mold or other contamination. The water is contained in a canister, which is removable from the unit and can be emptied and air-dried daily. I place the hose, with the stoma mask attached, in the dishwasher every few days for cleaning and sterilizing. The water from the canister never enters the unit, so there is no concern about having to clean the unit out. There is an air filter on the unit, so that all air being breathed is filtered. Filters are cheap and may be cleaned from time to time. I neglected to mention that the unit has a heating element, which heats the base of the canister, so that air passing over the water surface humidifies the air as it enters the hose and to the stoma mask. The air at the stoma mask is cool-humidified air.

This is not a solution for a person requiring a higher humidity level, but for me it is just right. The noisy-monster, provided by my insurance company, even though the humidity output was adjustable, it was unsatisfactory even at a low humidity setting and still produced more than I needed.

Here is another idea. There is a small portable humidifier which uses a regular drinking water bottle for the water source. Simply empty the drinking water from the bottle and fill with distilled water. The unit is a KAZ Model PH5700 which is a very nice, clean humidifier and, with a little work, the output can be modified to attach a hose and stoma mask. I have modified mine and carry it as a backup to my CPAP. The only modification required is to cut off the strap attachment on a stoma mask enough so the mask can be completely fitted over the KAZ output. When this is done, then using silicon cement, attach the modified stoma mask over the output vents of the KAZ. Now the hose can be attached to the KAZ and, when turned on, there will be cool steam at the stoma mask. I can not regularly use this because the output is too much for me. I believe the KAZ is sold through Bruce Medical or Luminaud and possibly other supply houses and is probably in the $50-$60 price range.
Don W. - CA 0107

IN THE HOSPITAL

In the orders your doctor gives the hospital should include that your chart says "laryngectomee. Total neck breather. If oxygen required, apply to neck only". If you use a TEP a note should also be attached to not remove it. The doctor's orders should also inform the respiratory service at the hospital that you will require humidified air supplied continually with a trach mask which fits loosely around your neck. Suction should also be hooked up and ready for you to use or the hospital staff should it be needed. A sign close to your bed repeating the "laryngectomee. Total neck breather, etc." would also be a good idea. And your chart should also read that you may not be able to speak. A placement close to the nurse's station is an especially good idea for larys. If the hospital has a way to remotely monitor your oxygen saturation level at any time you are sedated that is still another layer of protection since this would indicate if your stoma had become plugged with mucus.
David B. - VA

IN THE CAR

In most cars you may change the ventilation system from "fresh air intake" to "recirculation of the air." If you use the recirculation system, the humidity will increase immediately. If the windows mist up, the humidity will be near 100%, and it's time for getting fresh air intake again. May be you find the right balance just with a small opening of one window? No idea to bring a humidifier into a car!
Lorents G. - Norway

HUMIDIFIERS AND WHITE DUST

I have been reading all the postings about humidity and the white dust. I worked in the water industry for 22 years, so this may help. City treated water contains lime, salt or calcium to help soften the water. Home softeners also condition with salt or calcium. When the water is atomized and dries the dust is either lime, salt, or calcium. The use of distilled water (while expensive) will stop the white dust.
George C. - NJ

 

 

DON'T - USE OINTMENTS

QUESTION:  Dr. Peters, there was a big discussion recently in our WebWhispers online group about using ointments inside or around the stoma. What do you recommend in the use of antibiotic or antibacterial ointments

ANSWER:  That's a very interesting question.  I think that if the stoma has "matured" or completely healed that nothing is needed. If a raw area develops from say using your speech prosthesis then a short course of an antibacterial is indicated until the area heals.  I would not recommend a routine daily use of such products when nothing is wrong with the stoma.

I can think of three reasons that routine use should be discouraged. The first thing that comes to mind is that most antibiotic ointments have a petrolatum (ie petroleum) base.  If a big "glop" of that stuff gets aspirated and finds its way into the lungs then a lung abscess could result.

The  second has to do with the fact that the main function of having petrolatum in a medicine is that it makes a seal on the surface.  That is why we use it on a fresh wound cause it seals the bad guys out.  The other thing it does though is to seal moisture and any surface bacteria IN as well.  This will create a situation that is chronically "wet" and actually damage normal skin.

The last thing has to do with resistant bacteria.  When bacteria are chronically exposed to an antibiotic they mutate in such a
fashion that they become immune or resistant to that drug.  That is why antibiotics should always be used sparingly and only when truly indicated. The classic example of this is the horrible practice of prescribing antibiotics to treat a cold which is generally caused by a virus.

So, when you have to use an antibacterial medication to treat an area of irritation around your stoma, use it sparingly and use a water soluble CREAM that won't risk damaging the lungs.

Glenn E. Peters, M.D.

 

What is in Ponaris?  AmericanRx.com describes it as follows:

 

 

One ongoing concern for us all is the use of products designed and safety tested for one purpose being used by larys for another.  Since we larys are so few in number it should not come as much of a surprise that there would not be many products specifically designed with us in mind or even safety-tested for our use.  Many products which have been designed for use by non-larys to use by, for example, squirting into their noses, could be very unsafe to squirt into a stoma.  The reason is our changed anatomies.  For example, for a non-lary squirting a cold remedy product in their noses any excess is likely to end up in their stomachs and broken down by stomach acids and any waste products flushed out by the body's incredible waste disposal system.  The lungs, on the other hand, have very limited ways to get rid of contaminants, and squirting the products into the stoma could be a health hazard.

One way the lungs get rid of contaminants is to cough things out.  But we know that larys often must take some conscious steps to keep their respiratory systems functioning well with an adequate amount and flow of mucus moving upwards.

One troubling fact is that the respiratory cilia (microscopic hairs which line the trachea and bronchi) which carry mucus and whatever contaminants are suspended in it upwards and out stop functioning when the relative humidity level in the respiratory system drops to 30%.  And indoor humidity can drop this low, particularly during the winter.  The mucus becomes too thick to be moved at all by the cilia.  So contaminants suspended in the mucus remain in the respiratory system too long, and some of these contaminants and immobile mucus are associated with several diseases including emphysema and worse.

Many of us (certainly including me) abused our lungs for decades by smoking and breathing in lots of other garbage.  As a consequence, I am pretty leery of introducing anything into my lungs via the stoma other than water vapor from my humidifier and dampened stoma covers.

David Blevins, Va

 

 

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