FAQ23: Hints for Teaching Stoma Care?
by David Blevins
A few ideas on teaching stoma care:
(1) it is essential for the laryngectomee to monitor their stoma size because of the problem of stenosis (shrinking of the stoma)...particularly if they have not been provided with a soft silicon lary tube to wear at least while they sleep during the period of time it takes for the stoma to "mature"...or reach a more or less stable size. It is often many months before the stoma reaches this state. Stenosis happens to many larys (I remember vaguely a figure of about 1/3 or even more). And with lary tubes costing as little as $40, it is cheap enough "insurance" against stenosis.
(2) every new lary should be taught how to irrigate their stomas, at least if they face a situation where they must do so. The reason is mucus plugs which can develop, particularly soon after becoming a laryngectomee. Thick mucus can form a plug sufficient to block one or even both lungs. Larys need to recognize the symptoms particularly a sudden and unexplained shortness of breath, and to quickly irrigate to dislodge and expel the plug. We larys disagree on whether irrigation (also called lavage) should be a routine thing larys do on a daily basis. We disagree about (a) whether it ought to be done routinely (b) if done, what should be used (tap water, distilled or other sterile water, saline or plain, or any other preparation such as products designed to be sprayed into the nose). I think the safest general advice is to have some saline "bullets" (little ampules of sterile salt water) on hand in case of a mucus plug.
(3) it is essential that the stoma be covered at all times. This is the most sound medical advice to give to a new lary, although many of us do not follow it ourselves. But the medical facts support wearing a stoma covering at all times because larys have lost the filtering function of the nose and upper airway. Probably, in general decreasing effectiveness, the order would be first using HME filter. Next most effective would probably be a foam stoma cover, then a lined cloth stoma cover, and finally a plain cloth or crocheted stoma cover. This is general advice since it is possible that a plain cloth cover, for example, would be better than one lined with the wrong kind of fabric.
(4) since I think every new lary should have a soft silicone lary tube to combat stenosis, and each should be taught the proper method for inserting one. You can see this in this issue of the WebWhispers Journal: http://www.webwhispers.org/news/may2002.htm
(5) I believe it is prudent advice to give to larys to never put any kind of lubricant inside or even immediately adjacent to the stoma area. We have been particularly warned about routinely using "triple ointment" which contains an antibiotic since chronic use produces antibiotic resistant germs. Upon an MD's recommendation (hopefully one who knows what he/she is talking about), a little K-Y jelly on a rare occasion or other temporary use may be called for. But if the lary is taking care to keep the humidity up, cleaning around the stoma, and covering the stoma, there should not be many times when anything is needed.
(6) the single biggest issue for lary care for the stoma (and the rest of the respiratory system) is humidity. A great many of our problems such as a mucus plug or dry and even bleeding stoma is caused by the mucus lining of the stoma drying out. The way to prevent these problems is to increase the humidity of the air going into our stomas (or preserving some of the humidity otherwise lost through exhalation by using an HME). We do this by increasing our home humidity to a maximum of 60%, and adding humidity at the stoma level by dampening a foam or cloth stoma cover.
(7) using alcohol or peroxide wipes or just soap and water around the stoma is also good advice.
Do check our WebWhispers Hints section for more ideas. We have a whole section devoted to stoma care: http://www.webwhispers.org/pages/hints/stomacare.htm