A convex ostomy barrier is an appliance component designed with an outward curve on the side that adheres to the skin, differentiating it from a standard flat barrier. This dome shape is specifically engineered to manage stomas that are flush with the skin, recessed, or located within skin folds or creases. The convexity works by gently pressing the surrounding peristomal skin downward and outward. This creates a mild yet firm pressure that encourages the stoma to protrude slightly above the skin surface, which is necessary for directing output safely into the collection pouch. By ensuring the stoma extends beyond the barrier opening, the system significantly reduces the risk of leakage and skin irritation.
Essential Preparation Before Application
Thorough preparation of the skin and the new appliance is necessary to ensure the seal of the convex barrier is secure and long-lasting. Before removing the existing system, all necessary supplies must be gathered and laid out, including the new convex pouch, a measuring guide, adhesive remover wipes, skin barrier preps, and scissors if a cut-to-fit system is used. After gently removing the old barrier, the peristomal skin must be meticulously cleaned with plain water or a specialized ostomy cleanser. Avoid any soaps that contain oils or perfumes that could compromise the adhesive bond. The skin must then be completely dry, as residual moisture will prevent the hydrocolloid material from adhering properly to the skin surface.
A precise measurement of the stoma is particularly important when using a convex barrier because the snug fit is what creates the necessary gentle pressure. Using the measuring guide, the stoma’s widest diameter should be accurately determined, ensuring the opening is cut to fit closely around the base of the stoma without touching the stoma tissue itself. A gap that is too large will allow output to contact the skin, while a hole that is too small can cause trauma and swelling to the stoma. This close fit allows the convex shape to effectively apply pressure to the peristomal plane.
Step-by-Step Application of the Convex Barrier
The process of applying a convex barrier begins with warming the adhesive component, which significantly improves its flexibility and initial tack. Holding the barrier in the palms of your hands for approximately one minute allows the hydrocolloid material to become pliable, conforming more readily to the body’s contours upon application. If a cut-to-fit barrier is being used, the pre-cut opening should be checked against the stoma measurement to ensure the size is exact before the protective backing is peeled away. For two-piece systems, a small amount of barrier paste or a protective ring can be applied directly to the adhesive side of the barrier to fill any minor irregularities near the stoma base.
When aligning the barrier, it is helpful to position the body in a way that minimizes abdominal folds, such as sitting down or leaning slightly forward. The barrier should be aligned from the bottom edge of the stoma upward, ensuring the opening is centered and precisely fitted around the base of the stoma. Once the alignment is confirmed, the barrier is gently pressed onto the skin, starting from the center of the convex dome and moving outward toward the edges of the adhesive wafer. This technique ensures the pressure is applied first where the convexity is deepest.
Sustained, gentle pressure is then applied to the entire surface of the barrier for several minutes, often using the heat of the palm to further activate the adhesive bond. This prolonged contact allows the warm hydrocolloid material to mold itself into the skin’s micro-depressions and creases, optimizing the seal. If the product is a two-piece system, the pouch is then snapped or locked onto the flange, ensuring the connection is fully secure with an audible click or visual confirmation. Many convex systems also recommend the use of an adjustable ostomy belt, which hooks onto the pouching system and provides an added layer of security. The belt should be worn comfortably snug, allowing two fingers to easily slide underneath, as its purpose is to enhance the downward pressure of the convexity.
Maintaining the Seal and Addressing Common Issues
Immediately after application, it is beneficial to remain still for a short period, allowing the heat from the body and the applied pressure to fully cure the adhesive bond. During the wear time, consistent monitoring of the seal is necessary, visually checking the perimeter of the barrier for any lifting or signs of leakage, especially after physical activity or periods of high output. Minor leaks are often first observed as a slight darkening or breakdown of the hydrocolloid material near the stoma. To maximize the wear time, body movement should be considered, as bending or twisting can place shear stress on the adhesive, potentially compromising the seal.
Addressing Pressure and Leakage Issues
One issue specific to convex systems is the potential for skin irritation or bruising caused by the continuous pressure of the dome. If persistent redness, pain, or bruising is observed, the pressure may be too intense, and consultation with a stoma care nurse is advisable to explore a softer or shallower convex depth. The ostomy belt, if used, should be regularly checked and adjusted to prevent excessive tension, which intensifies the downward force. Addressing minor leaks quickly with barrier accessories, such as paste or rings, can temporarily reinforce the seal. However, frequent or persistent leaks indicate the need to reassess the fit, depth, or type of convexity being used.