1. The differences between 1- and 2-piece ostomy systems
You may know that there are different types of ostomy systems with which to manage your stoma. There is a choice of 1-piece and 2-piece systems.
With the 1-piece system the stoma pouch and the skin protective wafer are one single component. With the 2-piece system, the skin protective wafer (flange) and the pouch are two units. In addition, there are some ‘hybrid ostomy appliances’ which combine both one and two piece features.
The choice is yours. After all, it is about your stoma and your life. Opt for the system that makes you feel most secure and comfortable. However, it must be appropriate for your stoma type, and be free of leakages or skin irritations. In order to assist you in your selection, we have summarised all possible pro’s and cons.
|1-piece system||2-piece system|
|The thin skin barrier will follow the skin contours better.||The thicker skin barrier is somewhat more rigid because of the presence of the plastic coupling ring.|
|Changing of pouches may take more time.Closed pouches are generally changed 2-3 times daily; drainable and urostomy pouches are often changed daily. This may not be advisable for a sensitive skin.||Pouches can be changed rapidly, and the flange can be replaced once or twice a week.The skin barrier may last for 2-4 days. This benefits the skin. These usually thicker skin barriers may also be more skin-friendly and safer.|
|Once the appliance is adhered to the skin, changing its position is not possible.Very flat on the belly, hardly visible.||The pouch may be turned and re-positioned after it has been attached to the body side wafer.The system is – though reasonably flat – maybe slightly visible under clothing|
|The stoma may be more vulnerable behind a single layer of pouch film.||The flange will protect the stoma better.Takes up more space in the luggage.|
|The system is flatter and less conspicuous||2-piece systems are usually more economic (with proper use).|
|A 1-piece system is more costly because the (expensive) skin barrier is replaced each time.||After removal of the pouch, the skin protective wafer (flange) and the stoma can easily be cleaned.|
|It may seem more hygienic because thecomplete appliance is renewed in one go.|
|Limited possibilities to interchange with other types of pouch or appliances.The thinner skin barrier has less absorption capacity
|Universal system. The same flange can be alternated with several types of pouch, irrigation sleeves, plugs etc.The usually thicker skin barrier has more absorption capacity when perspiring|
2. The EuroTec 2 piece flanges..
Whatever 2-piece system of EuroTec you select, all skin barriers are of a proven quality and designed for a long wear time and optimum moisture control of the skin. They will also adhere to an irritated or damaged skin without any problem. No synthetic rubbers are added to our skin protective wafers.
Nothing equals the SuperSoft wafers in terms of softness, flexibility and comfort. This is the result of the thin foam layer which is attached to the topside of the wafers. This also makes the SuperSoft wafers safer than other wafers, which incorporate a polyethylene film, which can potentially cut into the stoma when the underlying adhesive has melted away. This risk is completely eliminated with SuperSoft wafers.
SUPERFLEX wafers are actually smaller circular-shaped SuperSoft wafers, picture framed by a breathing, skin friendly adhesive plaster.
The flexible hydrocolloid follows the contours of the skin, even if the stoma is slightly retracted. For deeply retracted stomas convex body side wafers are available, in convex (4 mm high) or in extra convex (7 mm high).
All wafers are available in a wide range of pre-cut stoma openings, which can be slightly stretched avoiding the need to cut the stoma opening.
The flanges are available in several sizes.
The COMBIMATE systems are available in the flange sizes 38 mm, 45 mm, 57 mm, 70 mm, 85 mm and 100 mm. FLEXIMATE systems are available in the flange sizes 40 mm, 50 mm and 60 mm.
The diameter of the flange is determined by the size of the stoma. The flange diameter must exceed the largest stoma diameter by at least 10 mm.
For special requirements, extra-large wafers of 15 cm x 15 cm are available in different versions. The adhesive surface of the 38 mm SuperFlex wafer is larger in diameter than the corresponding flexible wafer of ConvaTec, resulting in more security with stomas that produce very thin stool or urine.
If desired, these SuperSoft wafers can be combined with a separate Circlemate plaster. Should the skin be oversensitive to plasters, it is an option to finish the edges with the extremely skin friendly VARIMATE THIN strips.
3. The EuroTec pouches.
All EuroTec pouches are made of a high grade, multilayer film.
The beige pouches are finished on both sides with a breathing, non-woven fabric. This not only contributes to comfort when wearing but also creates a great look. The range consists of closed pouches, drainable pouches and urostomy pouches. In addition to these we also offer mini pouches and stoma caps. Each type of pouch is available in several shapes and sizes. Applying 1-piece pouches is much easier using the semi-transparent version. These pouches have an ‘inspection window’ on the front of the pouch which can be opened in order to make the stoma visible during the application of the pouch. It also allows interim inspections without removal of the pouch. A semi-transparent pouch can easily be converted into a fully transparent pouch, simply by removing the needle pin finish along the perforated edges.
The pouches of EuroTec also have an extra ‘raincoat’; an additional layer of film that separates the filter from the stoma. Special openings in the top of this ‘raincoat’ allow the gases to pass into the filter. EuroTec is virtually is the only manufacturer that adds an extra ‘raincoat’ to the inside of their closed pouches. The filters of the closed pouched can easily be closed off to prevent ‘pancaking ’by means of the added stickers, For bathing or swimming special GORE-TEX filter stickers are available. These filter stickers prevent water penetrating the filter, whilst the gases continue to escape from the pouch.
4. The bar filter.
The bar filter of EuroTec is a special one. It is wrapped in plastic film in such a way that gases enter the filter at either end and are forced to pass through the complete length of active carbon. This distance is substantially longer than with a round filter. Compared with the usual approximately 13 mm of a circular filter, the overall track is as much as 32 mm. That results in a longer action up to 24 hours. The closed and drainable pouches with a bar filter have an extra ‘raincoat’ layer that separates the filter from the contents of the pouch. In its separated chamber the filter will be kept dry under the toughest conditions. This makes the closed pouches suitable for people with loose stools as well. Drainable pouches are equipped as standard with a Gore-Tex membrane to prevent leakage or staining on clothing. These Gore-Tex membranes are also separately available.
5. Elastomers in the adhesive.
In the early seventies the introduction of Stomahesive was a real breakthrough.
For the first time there was an adhesive which adhered to both a dry and a moist skin, even when it was irritated. Even more, a damaged skin appeared to recover miraculously under this adhesive. Those simple wafers of 10 x 10 cm – at that time without a flange – soon received the nickname ‘cheese slice’. It could be combined with any brand of pouches. That superb adhesive – the hydrocolloid – became the base of virtually all subsequent stoma appliances, with a formulation that remained unchanged for decades.
The ingredients of this classis adhesive were costly and sometimes difficult to obtain in a constant quality. The colour of the hydrocolloid depended of the kind of pectin that was used and could vary from light yellow (lemon pectin) to ochre (pectin from oranges).
Unfortunately this successful formula became subjected to modification. Most manufacturers started to add elastomers to their hydrocolloids in the form of synthetic rubbers. These relatively cheap raw materials made the adhesive more flexible and elastic. This may sound like a good thing, but the elastomers substitute the expensive, beneficial moisture absorbing components.
The addition of synthetic rubbers condense the hydrocolloid, enabling the manufacturer to produce stable thinner wafers. A wafer with added synthetic rubbers will absorb substantially less moisture. A hydrocolloid with added elastomers is far less vulnerable and can be stored in large rolls over a long period, which is logistically beneficial for the manufacturer. This does not apply to hydrocolloid in the classic formulation which has to be stored in horizontal sheets with a limited stacking height. Also in the final packaging, the adding of elastomers can again save costs, because wafers made of classic hydrocolloids need to be properly packed in blister packs.
Unfortunately a hydrocolloid is often judged on its slimness and elasticity, but the moist absorption capacity and skin friendliness are far more important. A 2-piece ostomy system wafer is required to be a certain thickness in order to remain insitu for a number of days, and especially if the user is perspiring. Furthermore, people can be sensitive to these elastomers, a problem that is virtually unheard of with classic hydrocolloids.
Synthetic rubbers don’t always have disadvantages. With the Durahesive of ConvaTec the special elastomers contribute to the so called ‘turtle-neck’ effect, whereby the hydrocolloid creates a collar around the stoma. Elastomers can also reduce the amount of adhesive residue on the skin after removal of the wafer. Maybe you have used wafers containing elastomers for years without problems. No problem. But nowadays many users find that skin protective wafers have a shorter wear time than they were used to, particularly in warmer weather conditions.
Back to the quality of the early days
Instead of more frequent changing it may be preferable to switch to a hydrocolloid without added synthetic rubbers. A hydrocolloid that is able to absorb relatively more moisture and stay on the skin longer offers more security, is better for the skin and saves unnecessary costs.
The supposition that a thicker wafer is less flexible, is proven by the SuperSoft and SuperFlex wafers of EuroTec. These are substantially thicker than most other wafers and yet more flexible by their soft top foam layer. And they are completely free from synthetic and natural rubbers.
|The testThe presence of synthetic rubbers can easily be demonstrated. Take a wafer and pull off a piece of the adhesive with your finger nails. If this crumbles, there are (hardly) no elastomers present. However, if thin elastic-like threads arise or you can stretch the hydrocolloid without the development of bursts, you will know enough.|
The proof of the pudding: a wafer is stuck onto the inside of a glass of water which subsequently is tipped upside down. A good hydrocolloid will last long without breaking down . The right picture demonstrates that a hydrocolloid without added elastomers has a high capability of moisture absorption. This property is far more important for skin protective wafers than elasticity. EuroTec stick to the traditional formulation of hydrocolloid, despite costs or efforts.