The ostomy appliance is leaking, what do I do?

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If the patient has an enterocutaneous fistula (ECF), please consult with The Insides Company’s stomal therapist for an individualised solution.

It is known that pouching a patient with an ECF can be extremely difficult and distressing for the patient. It requires trial and error with many products and techniques in order to protect the peri-fistula skin and direct the flow of chyme into the ostomy appliance.

Things to consider:

  • Reflux – A constant flow of chyme over the hydrocolloid at the aperture of the ostomy appliance will degrade the hydrocolloid quickly and cause leaks. Review the cause of reflux.
    • Reduce the speed of The Insides® Driver to reduce reflux.
    • Reinfuse smaller and more frequent boluses to reduce reflux.
    • Is it temporary and will resolve once the gut has rehabilitated?
    • Is the patient constipated?
    Due to the undulating abdominal landscape, accessories such as hydrocolloid seals and paste are strongly recommended. Consider building up the seals to increase absorbency and reduce the deterioration of the seal.
  • Chyme viscosity – Water thin chyme not only increases the risk of dehydration but also the risk of the chyme sliding underneath the aperture of the ostomy appliance and creating a leak. Consider thickening the chyme via anti-motility medication to reduce this risk. However, the thickness of chyme must remain within a normal range to reinfuse. Anti-motility drugs can also cause constipation downstream of the stoma.
  • Retention sleeve – Does the retention sleeve on the Tube get caught on the aperture of the ostomy appliance? Lift the tube into a horizontal position when threading the ostomy appliance on. This ensures the retention sleeve clears the edge of the ostomy appliance and sits completely inside the pouch.
  • Night bag – To stop chyme pooling at the aperture of the ostomy appliance, attach a night bag to the end of a high output drainable ostomy appliance. This creates a vacuum and draws the chyme away from the aperture. If this option is used, ensure the patient is wearing a 2 piece or an ostomy appliance with a window so chyme can be transferred back into the pouch to be reinfused.
  • Ostomy appliance – Ensure all recommended manufacturer’s guidelines are being followed when applying the ostomy appliance. An example of this is warming the hydrocolloid before application. 

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