Fit Indicator Tool

Welcome

FIT
Fit Indicator Tool

About the Guide

Developed with an international panel of experienced stoma care nurses, a new assessment tool has been designed to provide a simple patient assessment methodology to determine the need for a flat or convex barrier. Finding the right barrier fit for the patient helps provide the most secure seal around a stoma which helps prevent leakage and peristomal skin problems. This tool has been created to assist both the experienced and novice clinicians during patient assessment. It is not meant to prescribe specific types of products or product features.

Barrier Options in Ostomy Care

Flat barriers provide flexibility and generally give patients a low-profile pouching system option. If the patient’s stoma sticks out at least an inch from the body, a flat skin barrier could be the best barrier option. Convex products (wafers, faceplates, skin barriers, or convex rings) curve outward toward the peristomal skin^{1, 2} to increase the depth of the skin barrier. This outward curving of the skin barrier is designed to interface with the immediate peristomal skin, promoting a good seal between the ostomy pouching system and skin where flat skin barriers would be unsuccessful. This interface depends not only on the depth, rigidity, and gradient of the convex skin barrier, but also on the shape and rigidity of the abdominal wall.³ A secure and reliable skin seal is necessary to protect peristomal skin from stoma discharge.

Assessing for the Right Barrier Fit

Fit is a critical element in the world of ostomy care. A good seal around the stoma helps prevent leakage; a factor that can directly impact skin health. For many people with ostomies, achieving a good fit around the stoma can be challenging. The presence of skin folds, recessed stomas, or other issues can add to these challenges. For several decades, convex ostomy products have often been utilized to help improve patient outcomes. While many patients may require convexity either temporarily or permanently, a simple patient assessment methodology to determine its need has been lacking. This often leaves clinical decisions to experience without supportive evidence.

Acknowledgements

Hollister Incorporated would like to acknowledge the Convexity Advisory Board who authored the FIT(Fit Indicator Tool):

Sandrine Diallo, RN, ET, Private Community Practitioner, Cagnes, France
Colleen Drolshagen, RN, CNS, CWOCN, Cadence Health, Winfield, IL USA
Juliette Fulham, BSc, SCN, RGN, Wexham Park Hospital, Slough, England
Jo Hoeflok, RN(EC), BSN, MA, CETN(CN), CGN(C), St. Michaels Hospital, Toronto, Canada
Julia Kittscha, RN, BHSc, STN, MN (Research), Wollongong Hospital, New South Wales, Australia
Mariló Ruiz, RN, ET, Hospital Valme, Seville, Spain
Joy Boarini, BSN, MSN, WOC Nurse, Hollister Incorporated, Libertyville, IL USA
Diane Owen, BSN, MBA, Hollister Incorporated, Libertyville, IL USA
Paris Purnell, RN, STN, Hollister Incorporated, Victoria, Australia

Let’s get started

This brief tutorial will walk you through
the assessment and scoring process

1Position

Patients should be assessed in a variety of positions with the pouching system removed.

Ideally, the abdomen should always be assessed in the sitting position.

Then have the patient perform positional changes, such as lying, standing, sitting, bending, and twisting, wherever possible.

These changes might identify potential problems that impact the wear time of the pouching system and the integrity of peristomal skin.^3,4

Considerations should also include prosthetics, wheelchairs, and other activities of daily living (e.g., sports, swimming).

Note: This assessment is not for use with infants.

2Assess

Select a response to each question as directed.

3View

To guide you, clinical image references and definitions are available within the assessment. A full library can be found in the main menu.

3View

In addition a full library can be found in the main menu.

4Score

Your patient’s convexity assessment score will be tallied and will appear at the end of the assessment questions.

5Report

Click the Download as PDF button to create a printable PDF for your files and/or to share with your patient.

6Refer

For your reference, the method for determining your assessment score can be found next to the patient summary.

7Repeat

Patients' convexity should be assessed regularly to track their progress.

Start an Assessment

- or -
Repeat Tutorial

Image Library

Stoma Assessments

End Stoma

An end stoma results when the distal portion of the GI or urinary tract is removed or over sewn. The result is one stoma with one opening.⁵

References

Loop Stoma

A loop stoma results when a loop (segment) of bowel is brought through the skin on the abdomen to create a diversion for the passage of feces. There is one stoma with two openings — proximal or functioning and distal or non-functioning. These stomas may have a supporting device (rod, bridge) used. The distal stoma may secrete varying amounts of mucous.⁵

References

Stoma Protrusion

An ideal fecal or urinary stoma protrudes at least 20 mm (approx. 3/4") above the skin level.⁵

References

Flush Stoma

A stoma that is level with the peristomal skin.⁷

References

Retracted Stoma

The disappearance of normal stomal protrusion in line or below skin level. Also known as Recessed Stoma.⁸

References

Stoma Opening

Centered stoma opening

Off-centered stoma opening

An ideal fecal or urinary stoma protrudes at least 20 mm (approx. 3/4") above the skin level.⁵

References

Flush Stoma

Image Not Available

Exaggerated stoma movement with normal peristalsis; the stoma can retract to or below the skin surface, or protrude excessively. A telescoping stoma can contribute to leakage, as the transient retracted state of the stoma can allow effluent to undermine the barrier.⁴ Please observe the stoma in both active and inactive states (where possible) to determine telescoping as described.

References

Peristomal Assessments

The peristomal plane involves the area immediately around the stoma. This includes the skin and underlying tissues. Ideally the topography of peristomal plane should remain flat, symmetrical, and free from irregularities during positional changes.⁴

References

Topography/Peristomal Plane

Flat

Even/smooth peristomal skin surface.

Herniated/Bulging*

A defect in abdominal fascia that allows the intestine to bulge into the parastomal area. Also known as Peristomal Hernia.⁸

References

Uneven/Irregular

Uneven and irregular peristomal skin surfaces.

Abdominal Tone Considerations

Soft Abdomen

An abdomen with normal skin tone and turgor on palpation.

Firm Abdomen

Abdominal tone is unyielding on palpation (e.g., ascites, hernia, obesity). If the patient’s abdomen is too tense, the application of an opposing force from a convex skin barrier may also result in higher pressure forces being exerted on the peristomal skin, resulting in pressure injury.⁴

References

Flaccid Abdomen

A very soft abdomen with poor skin and/or muscle tone around the stoma. Also known as a "flabby abdomen".

References

Peristomal Skin Disorders

Peristomal Varices*

Large portosystemic venous collateral blood vessels occurring at the site of a stoma. Also called Peristomal Caput Medusae.⁸

References

Peristomal Pyoderma Gangrenosum (PPG)*

Ulcerative skin condition of unknown etiology occurring around the stoma. Ulcer edges are bluish, often ragged, developing on peristomal skin. Often can present as a deep ulcer with a well-defined border, which is usually violet or blue.⁸

References

Crohn's Ulcer*

The extraintestinal manifestation of Crohn’s Disease, where ulcers of various size and depth present on peristomal skin.¹¹

References

Pressure Injury

Pressure injury may result from forces being exerted on the peristomal skin where opposing forces create tissue damage from higher pressures.4 Pressure injuries may present as localized injury to the peristomal skin and/or the underlying tissues and are often attributed to belts or incorrect skin barrier fit.¹²

References

*NOTE: These conditions do not preclude the use of convexity products. However, caution and frequent reassessment with convexity is recommended in patients with a history of pyoderma gangrenosum, caput medusae, pressure ulcers, mucocutaneous separation, parastomal hernia, Crohn’s ulcers, or malignant ulcers, as further peristomal skin damage can occur.¹⁰

Welcome

FITFit Indicator Tool

About the Guide

Let’s get started

This brief tutorial will walk you throughthe assessment and scoring process

1Position

2Assess

3View

3View

4Score

5Report

6Refer

7Repeat

Fit Indicator Tool

End Stoma

Loop Stoma

Stoma Assessment

For End and Loop Stomas

Stoma Opening

Flush Stoma

Retracted Stoma

Stoma Protrusion

Flush Stoma

Stoma Protrusion

Flush Stoma

Distal Stoma Assessment

For Loop Stomas Only

Stoma Opening

Flush Stoma

Retracted Stoma

Stoma Protrusion

Flush Stoma

Peristomal Assessment

For All Stoma Types

Flat

Herniated/Bulging*

Uneven/Irregular

Peristomal Varices*

Peristomal Pyoderma Gangrenosum (PPG)*

Crohn's Ulcer*

Pressure Injury

Soft Abdomen

Firm Abdomen

Flaccid Abdomen

Patient Assessment

Assessment Score

Patient Summary

Assessment Score Indicator

Image Library

Stoma Assessments

End Stoma

Loop Stoma

Stoma Protrusion

Flush Stoma

Retracted Stoma

Stoma Opening

Flush Stoma

Image Not Available

Peristomal Assessments

Topography/Peristomal Plane

Flat

Herniated/Bulging*

Uneven/Irregular

Abdominal Tone Considerations

Soft Abdomen

Firm Abdomen

Flaccid Abdomen

Peristomal Skin Disorders

Peristomal Varices*

Peristomal Pyoderma Gangrenosum (PPG)*

Crohn's Ulcer*

Pressure Injury

FIT
Fit Indicator Tool

This brief tutorial will walk you through
the assessment and scoring process