Good intact skin is a goal of pouching. At times areas of skin under the skin barrier may become broken down, open, and/or weeping when there is skin shear in removing the skin barrier or leakage of output, called effluent, on the skin which can irritate and burn the skin.
When skin is moist the pouch skin barrier will not stick well; the procedure of crusting can help in allowing the barrier to adhere well.
What is Crusting?
Crusting is a procedure used to create an artificial scab on weeping/broken skin around the stoma and under the skin barrier (aka Peristomal skin). This is done by using stoma powder and a skin prep polymer liquid. Crusting can protect the peristomal skin from waste output, absorb moisture, and increase pouch wear time resulting in fewer pouch changes and less disruption to irritated peristomal skin.
Indications:
Denuded/weeping peristomal skin
Use to absorb moisture from broken skin around the stoma
Contraindications:
Allergy to any of the products
Stop using the powder when the skin has healed and is no longer moist to the touch.
Powder is not indicated for the prevention of skin irritation.
Supplies:
Skin barrier powder (Anti-fungal powders like Nystatin may be substituted)
Non-alcohol (sting free) polymer skin barrier wipes or spray
Clean gauze 4×4’s, tissue or cloth like paper towel to dust off excess powder
Steps
1. Cleanse peristomal skin with water (avoid soap) and pat area dry.
2. Sprinkle skin barrier powder onto broken/weeping skin.
3. Allow powder to adhere to the moist skin.
4. Dust off excess powder from the skin using gauze, soft cloth like paper towel or a soft tissue. The powder should stick only to the raw area and
not be left on dry intact skin.
5. Using a blotting motion, apply the polymer skin barrier wipe to the skin and over the powder. Skin prep spray may also be used.
6. Allow the area to dry.
7. Repeat steps 2 through 6, up to 3 layers to achieve a crust layer.
8. Apply pouching system over the crusted area
Colorado River Ostomy Chapter 