Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults

Abstract

PURPOSE: This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. METHODS: Scoping review and generation of evidence and consensus-based clinical guidelines. SEARCH STRATEGY: The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: “stoma preparation,” “stoma creation,” “stoma complications,” “stoma care,” and “stoma reversal” (for enteral stomas).” All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. FINDINGS/CONCLUSIONS: This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

Use of a Convex Pouching System in the Postoperative Period

“…However, a smaller study by Salvadalena45 found an incidence of less than 3%. Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults15 advised against the use of convexity during the first postoperative days. However, the panel strongly supported that finding a pouching system that can achieve predictable wear time was the overriding goal and determined that the risk of mucocutaneous separation that can be managed with effective wound care did not outweigh this fundamental goal of care 43,46,47.…”

“…[21][22][23][24][25][26] A single clinical practice guideline from the Multidisciplinary Italian Study Group for Stomas was identified that advised against the use of a convex pouching system during the "first postoperative days" due to concerns regarding the potential for mucocutaneous separation. 15 This recommendation was based on expert opinion rather than supporting evidence and the time frame was not further identified. Based on these apparent gaps in evidence and paucity of best practice guidance, the panel moved forward with generation of best practice statements guiding the use of convexity during the postoperative period.…”

“… 27 – 29 The other elements were protocols for the nursing management of patients with an ostomy, best practice documents, and consensus statements or reviews. 13 – 15 , 30 – 38…”

“…No studies were retrieved that evaluated the efficacy or safety of the use of a convex pouching system during the postoperative period 21–26. A single clinical practice guideline from the Multidisciplinary Italian Study Group for Stomas was identified that advised against the use of a convex pouching system during the “first postoperative days” due to concerns regarding the potential for mucocutaneous separation 15. This recommendation was based on expert opinion rather than supporting evidence and the time frame was not further identified.…”

Survey Results on Use of a Convex Pouching System in the Postoperative Period

“… 2 , 3 Best practice guidelines consistently recognize that a secure seal around the stoma is required to minimize leakage that is associated with peristomal skin complications and diminished health-related quality of life. 4 – 6 …”