Meanings attributed to complications of ostomy and skin peristhectomy in a public reference service in the Cariri region

Objectives: To present the meanings attributed by participants or their caregivers in relation to complications of the ostomy and peristomal skin in a referral service in the Cariri region. Methods: Descriptive research, of a qualitative nature, composed of 24 participants with intestinal ostomies. The data were collected in the period of March and June of 2018 in the Service of Health Care of the Person with Ostomy located in the city of Juazeiro do Norte, state of Ceará. The interviews were guided by a structured script and recorded through a mobile app. During the data analysis, participants’ answers were transcribed in its full. Results: From the report of the participants, the following meanings for the complications of the ostomy and peristomal skin emerged: aspects related to the quality of the collecting equipment, such as time of permanence of the bag, type of bag and adhesiveness; fragility in the educational process; and eﬀ ectiveness of surgical procedures. Conclusion: The provision of specialized assistance is necessary so that the orientations of the professionals are directed to the individual needs of each participant, since health care is based on an interpersonal process centered on the integral care of the individual and his or her family.


INTRODUCTION
Ostomy is understood to be a surgically produced opening for temporarily or permanently communicating a hollow organ with the external environment through the skin 1  Complications related to the ostomy may be classi ed as early (bleeding, edema, infection, peristomal dermatitis, retraction, ischemia or externalized loop necrosis) or late complications (stenosis, obstruction, prolapse, paresthetic hernia, and stulas) 6 .
A cross-sectional retrospective study of 572 records of people with ostomies treated at the Ostomized Association of Rio Grande do Norte, from 1991 to 2015, showed that dermatitis, prolapse, paraestomal hernia, and stomatal retraction were the most common complications frequently observed in this population 7 .
adequate surgical techniques 8 . The stomatal demarcation consists in determining limits for its preparation and can be performed by the stomatologist nurse in order to promote, during the surgical act, the creation of an opening in a suitable place that allows the adaptation of equipment for the collection of effluents with minimum discomfort for the patient 9 .
Following the standardization of the stomatal location significantly reduces the rate of complications, since placing the ostomy in an area that ensures the equipment adherence and is easy to visualize for the person constitutes a strategy to prevent complications such as stenosis, prolapse, retraction, and ischemia 10 . Thus, the choice of adequate collection equipment by the stomatherapist coupled with the teaching of self-care is fundamental to avoid the appearance of this type of complication 16 .
As a general rule, the best collecting equipment is the simplest, most comfortable, practical, safe, discreet, lowest cost and that suits the stoma and protects the peristomal skin, so it is up to the professional to explain to the person with advantages and disadvantages of each bag according to individual characteristics and personal choice 1 .
For some participants with ostomies, the prolapse presented in the ostomy is due to the physical effort: This happened like this, it was the weight I carried once. In view of the facts, the incorporation of a stoma therapist nurse at the service, especially in those who have few resources, greatly reduces the complications in the stoma and the peristomal skin. Another strategy to reduce these complications is the preoperative demarcation of the ostomy 21 .
A study carried out with medical surgeons in the period from 2014 to 2015 revealed that the assistance provided by these professionals to people with ostomies was basically restricted to the manufacturing of the ostomy and initial clinical conduct, requiring the referral of these people to specialized services in order to ensure continuous follow-up after discharge from hospital 22 .
In this context, nursing in stomatherapy has been highlighted as a facilitator of the care process, occupying a differentiated position among the professionals who provide assistance to people with ostomies, since, besides accompanying the entire process of making the ostomy, it acts to prevent complications and prepare for the process of adaptation and self-care.
The inappropriate use of the bags was also cited by the caregiver participants as the cause for the appearance of dermatitis in the peristomal skin: