Maggie McKay (Host): Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad, everyday health topics, to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Maggie McKay. Thanks for listening.

Today, we have with us Kelly Rainville, Manager of the Wound, Ostomy, and Continence Nursing Center. Thank you so much for being here, Kelly.

Kelly Nicole Rainville, MSN, RN, CWOCN: Thank you so much for having me.

Host: What conditions do you treat?

Kelly Nicole Rainville, MSN, RN, CWOCN: So, our center treats venous and arterial wounds. We see lymphedema wounds, minor first and second degree burns, diabetic wounds, pressure injuries, traumatic wounds such as from a fall or an accident. We see various different surgical wounds. And skin problems related to incontinence, skin problems related to ostomies, and any other chronic non-healing wounds.

We offer numerous treatments with specialized wound dressings. We have various types of debridement, including ultrasonic debridement. We do compression therapy with multi layer wraps, applications of skin substitutes, and negative pressure wound therapy, which is more commonly known as a wound vac. We also measure patients for compression socks and can complete a lymphedema pump evaluation for patients that may have chronic lymphedema to their bilateral lower legs.

Host: Wow. That is a lot. You said you measure for the socks?

Kelly Nicole Rainville, MSN, RN, CWOCN: Yeah, so a lot of the time when patients struggle with vascular wounds, there's typically swelling related. And once we get the swelling down with compression wraps, we transition them into compression socks. So we'll do the measuring for those compression socks and help them order the appropriate size so that they can really maintain that leg swelling.

Host: What is an ostomy?  

Kelly Nicole Rainville, MSN, RN, CWOCN: An ostomy is a surgically created opening in the abdomen. So what the surgeon will do is they'll bring a piece of the intestine to the surface of the skin of the abdomen to create something called a stoma.

Over the stoma, a drainage bag or pouch is attached to collect urine or stool depending on the type of the ostomy. A colostomy or ileostomy drains stool, and a urostomy or ileoconduit drains urine. Someone may need an ostomy if they have a certain medical condition involving their intestines or bladder.

Host: How can your center help someone with an ostomy?

Kelly Nicole Rainville, MSN, RN, CWOCN: Our Wound Ostomy and Continence Center offers services for patients prior to and after ostomy surgery. Often before a surgery, we meet with patients and we'll do a pre operative marking on their abdomen. This marking helps the surgeon place the ostomy during the surgery and we'll review some basic education with the patient, explaining what to expect before and after surgery.

And then our center is also available to be a resource to patients after their ostomy surgery to reinforce any ostomy teaching and we can help with any complications like leaking from under the ostomy appliance, skin irritation around the ostomy, and fitting for the proper ostomy appliance. We also measure for peristomal hernia belts, which are belts that support a hernia around the ostomy.

Host: What causes skin irritation in people who have incontinence? 

Kelly Nicole Rainville, MSN, RN, CWOCN: Skin irritation in people who have incontinence is caused by prolonged exposure of the skin to either urine, stool, or both. And this exposure causes increased permeability of the skin. It also causes a rise in the pH of the skin. And this can lead to the breakdown of the skin's natural protective barrier and leaves that skin red and irritated. 

Host: So if keeping your skin moisturized is part of the treatment, doesn't that contribute to the moisture problem?

Kelly Nicole Rainville, MSN, RN, CWOCN: It's important to keep the skin balanced, so when it comes to incontinence, prevention is really key. The best way to keep this balanced and protect the skin is by using something called a moisture barrier ointment.

Host: So a moisture barrier ointment, is used to protect the skin and it restores that moisture barrier function to the skin. These ointments allow the skin to breathe, but protect the skin from maceration or, that just really wet look to the skin. It's important to apply a moisture barrier ointment on the skin with each incontinent episode after cleaning the skin so that, you can really just prevent that skin from breaking down. You really want to avoid products with fragrances and dyes, which could cause further skin irritation.

What are some products that we all know of that we could use when you were talking about protecting the skin, but making a barrier at the same time?

Kelly Nicole Rainville, MSN, RN, CWOCN: You want to look for zinc oxide based products. Over-the-counter, there's butt paste or Desitin or Balmex. These are all good examples of moisture barrier ointments that you can use at home.

Host: What's a pressure injury? 

Kelly Nicole Rainville, MSN, RN, CWOCN: A pressure injury is an injury to the skin or any of the underlying tissue under a bony prominence. Pressure injuries are caused by prolonged pressure or sheer forces on the skin and can lead to cell death or deformation. Common areas for pressure injuries are the sacrum, the buttocks, the heels, the elbows, anywhere with a protruding bone.

Pressure injuries can also occur from a medical device. So, for example, an orthopedic splint, which makes it really important to make sure you're assessing the skin under any medical device.

Host: Kelly, how do you know if your wound is not healing?

Kelly Nicole Rainville, MSN, RN, CWOCN: So, we usually tell patients if your wound doesn't improve within the first week or so of standard care with an ointment and bandage, there could be a delay in healing. If the wound develops increasing redness or swelling around the edges, that might indicate an infection is developing also, so you should seek care.

There are certain conditions that delay healing, such as diabetes, vascular disease, aging, and smoking. And there's also medications that delay healing, such as corticosteroids, chemotherapy, and anticoagulants. If you have any of these conditions, it is a good idea to call our center and have a certified wound ostomy and continence nurse treat your wound

Host: And if a wound has redness around it or odorous drainage, should one be worried?

Kelly Nicole Rainville, MSN, RN, CWOCN: Redness around a wound is expected because the body's wound healing occurs as an inflammatory response, which causes mild redness around the wound. However, if you feel the redness is starting to grow, the drainage has a foul odor, or you develop a fever, it might indicate there's an infection and you should seek care immediately.

Host: And what should someone with diabetes watch out for?

Kelly Nicole Rainville, MSN, RN, CWOCN: So patients with diabetes have to be really careful because diabetic patients often have sensation problems, especially if the wound is on the lower extremities or feet. Diabetics should check their feet daily with a mirror to inspect all surfaces for trauma. It's important for diabetics to be wearing shoes around the house because if they step on something, many times they don't feel the trauma.

If there is a wound present, they should have their provider check it regularly because diabetes can mask the signs and symptoms of an infection.

Host: How long should someone wait before they call the wound care center?

Kelly Nicole Rainville, MSN, RN, CWOCN: We're asked this question often and I always encourage patients to give us a call and speak to one of the nurses if they have any sort of concern. All the nurses in our center are board certified wound ostomy and continence nurses, and they would be happy to talk to anyone to discuss the issue they're having and to determine whether or not they should make an appointment for care. 

We are very intentional about staying up to date with the latest treatments and supplies available and offer individualized treatment plans based on the patient's need.

Host: Thank you so much for sharing your expertise with us today. We really appreciate it.

Kelly Nicole Rainville, MSN, RN, CWOCN: Thank you so much for having me, I've enjoyed the time. 

Host: Same here. Again, that's Kelly Rainville. For more information about wound, ostomy, and continence services at Valley, please visit ValleyHealth.com/wound or call 201-447-8345 to schedule an appointment. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6090 or email valleypodcast at valleyhealth.com.