17 World Council of Enterostomal Therapist (WCET)                    Congress          “All roads lead us together”       ...
Multicenter Observational Study on Peristomal Skin Disorders:                                            A Proposal of Cla...
Multicenter Observational Study on Peristomal Skin Disorders:                                                             ...
Multicenter Observational Study on Peristomal Skin Disorders:                                              A Proposal of C...
Multicenter Observational Study on Peristomal Skin Disorders:                                             A Proposal of Cl...
Multicenter Observational Study on Peristomal Skin Disorders:                                                  A Proposal ...
Multicenter Observational Study on Peristomal Skin Disorders:                                                             ...
Multicenter Observational Study on Peristomal Skin Disorders:                                  A Proposal of Classification
This study was published in the Journal           OWM - OSTOMY WOUND MANAGEMENTA proposal for classifying peristomal skin ...
Multicenter Observational Study on Peristomal Skin Disorders:                                                             ...
Multicenter Observational Study on Peristomal Skin Disorders                                                              ...
Multicenter Observational Study on Peristomal Skin Disorders:                                  A Proposal of Classificatio...
Patient Demographic Group 1                        <1 year after surgery                              (N = 380)Gender (%) ...
Patient Demographic Group 2                        >1 year after surgery                              (N = 276)Gender (%) ...
Multicenter Observational Study on Peristomal Skin Disorders:                                                  A Proposal ...
The peristomal complication    classification system developersagreed to identify the quadrants around  the stoma in a man...
Classification                          Topography• L1 Hyperemic lesion (peristomal  skin reddening without loss of       ...
Brochure             Once it was ascertained that the             classification system was a helpful             tool, a ...
Peristomal   Skin Integrity
SACS Classification:L1: Hyperemic lesion      TV: total
SACS Classification:L2: Erosive lesion withloss of substance notextending beyond the        dermis       TV: total
SACS Classification: L3: Ulcerative lesionextending beyond the        dermisTIII-IV: lower right and        lower left
SACS Classification:      L4: Ulcerativefibrinous/necrotic lesionTIII-IV: Lower right and         lower left
SACS Classification:LX: Proliferative lesions (granulomas, oxalate  deposits, neoplasm)        TV: total
“Improving and maintaining the integrity ofperistomal skin is an important objective for   both ostomy patients and ostomy...
THANK YOU TO:     A.I.O.S.S.  (Italian   Association   of     Enterostomal Therapist)     CONVATEC ITALY     The collegues...
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Multicenter observational study on peristomal skin disorders

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Multicenter observational study on peristomal skin disorders

  1. 1. 17 World Council of Enterostomal Therapist (WCET) Congress “All roads lead us together” Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification Mario Antonini ET Nurse – U.S.L. 11 Local Health Agency – San Giuseppe Hospital, Empoli, Italy mantonini11@alice.it
  2. 2. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification“How well ostomy patients adapt to their new life depends, to a great extent, on the preservation of peristomal skin integrity”
  3. 3. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification The incidence of peristomal complications that can compromise that integrity cannot be easily determined. *A review of literature indicates a complication incidence ranging from 18% to 55%.* Colwell J, Goldberg M, Carmel J. The state of the standard diversion. JOWCN2001; 28 (1): 6-17
  4. 4. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification “In the authors experience caring fornearly 700 patients per year over a mean period of 10 years, it is estimated that at least one third of colostomy patients and up to two thirds of urostomy and ileostomy patients are affected by at least on peristomal lesion.”
  5. 5. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification “Because the literature shows no evidence of a tool classify peristomal skin disorders, a prospectiveobservational study was conducted among eight ostomy centers across Italy.”
  6. 6. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification “A study group comprised of seven enterostomal therapy nurses and foursurgeons sought to provide an objective,reproducible, standardized classification instrument.”
  7. 7. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification Ostomy Centers across ItalyAmbulatorio StomaterapiaOspedale “San GiovanniBattista”Le Molinette – Torino Ambulatorio Stomaterapia Azienda Ospedaliera “San Maurizio” - Bolzano Ambulatorio StomaterapiaAmbulatorio Stomaterapia Ospedale “Misericordia eOspedale “San Giuseppe” – Dolce” – Azienda U.S.L. 4Azienda U.S.L. 11 Empoli PratoAmbulatorio Stomaterapia Ambulatorio StomaterapiaAzienda Ospedaliera Policlinico Universitario“Garibaldi” - Catania “Campus Biomedico” - RomaPresidio Ospedaliero “SanLuigi Curro” - Catania Ospedale “Piemonte” - Messina
  8. 8. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification
  9. 9. This study was published in the Journal OWM - OSTOMY WOUND MANAGEMENTA proposal for classifying peristomal skin disorders: results of a multicenters observational study 2007; 53(9): 38-43
  10. 10. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of ClassificationSkin lesions were examined at set intervals (weeks 0, 4, 12, 24)Acquisition of digital imagesBlood chemistryDescriptive statistical analyses were conducted using the software SPSS 14.0Consensus Conferences
  11. 11. Multicenter Observational Study on Peristomal Skin Disorders Patient Demographic Group 1 <1 year after surgery Time 0Patien PARAMETRI CLINICI t Body Pictu Blood Blood Bleeding at Name Data Hemoglobin Weight Diuretic Degree of Peristomal skin lesion (1,2,3,4,X) Burning Itching Pain Bleeding Localization re sugar Iron removal (kg) 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 020
  12. 12. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of Classification February 2006 December 2003 A prospective, observational study was conducted between December 2003 and February 2006.
  13. 13. Patient Demographic Group 1 <1 year after surgery (N = 380)Gender (%) Male: 60% Female: 40%Age Minimum: 25 years Maximum: 85 yearsStoma type (%)- Ileostomy 28,6%- Colostomy 71,4%Permanent stoma 62,6%Temporary stoma 37,8%Systemic disease Cardiopathy: 9,1% Arterial Hypertension: 8% Diabetes: 11,2%
  14. 14. Patient Demographic Group 2 >1 year after surgery (N = 276)Gender (%) Male: 65% Female: 35%Age Minimum: 26 years Maximum: 91 yearsStoma type (%)- Ileostomy 31,9%- Colostomy 68,1%Permanent stoma 87,5%Temporary stoma 12,5%Systemic disease Cardiopathy: 4,2% Arterial Hypertension: 8% Diabetes: 11%
  15. 15. Multicenter Observational Study on Peristomal Skin Disorders: A Proposal of ClassificationPeristomal: the term “peristomal”is meant to include the whole skinaround the stoma (within 7,5 cm,which is the maximum size of theskin barriers available in themarket), even if it is not directlylinked with the stoma. Predominant sign: it was decided that the classification should only refer to the predominant sign (the most serious one) and the topography (T) of the lesion; the classification will then include only one “L” and in case more than one “T”.
  16. 16. The peristomal complication classification system developersagreed to identify the quadrants around the stoma in a manner similar to thesystem used for breast cancer patientsto facilitate topographical description of the lesions 7,5 cm 7,5 cm
  17. 17. Classification Topography• L1 Hyperemic lesion (peristomal skin reddening without loss of • TI = Upper left substance)• L2 Erosive lesion with loss of • TII = Upper right substance NOT extending beyond the dermis • TIII = Lower right• L3 Ulcerative lesion extending beyond the dermis• L4 Ulcerative fibrinous/necrotic • TIV = Lower left lesion• LX Proliferative lesions • TV = Total (granulomas, oxalate deposits, neoplasm)
  18. 18. Brochure Once it was ascertained that the classification system was a helpful tool, a pocket ruler guide for the classification was created to provide a brief summary and practical explanation on the classification system to be used by ET nurses in daily work.Ruler
  19. 19. Peristomal Skin Integrity
  20. 20. SACS Classification:L1: Hyperemic lesion TV: total
  21. 21. SACS Classification:L2: Erosive lesion withloss of substance notextending beyond the dermis TV: total
  22. 22. SACS Classification: L3: Ulcerative lesionextending beyond the dermisTIII-IV: lower right and lower left
  23. 23. SACS Classification: L4: Ulcerativefibrinous/necrotic lesionTIII-IV: Lower right and lower left
  24. 24. SACS Classification:LX: Proliferative lesions (granulomas, oxalate deposits, neoplasm) TV: total
  25. 25. “Improving and maintaining the integrity ofperistomal skin is an important objective for both ostomy patients and ostomy care professionals.Peristomal skin integrity plays a fundamentalrole in the improvement of quality of life of a patient with an abdominal ostomy.”
  26. 26. THANK YOU TO: A.I.O.S.S. (Italian Association of Enterostomal Therapist) CONVATEC ITALY The collegues of the study THANK YOU FOR YOUR ATTENTION!

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