Q: We have a resident with a new ostomy and are having trouble keeping an appliance in place. The incision is healed and the resident is back to normal, but the leaking appliance is holding her back from her normal routine. What do we do?

A: First of all, congratulations for getting her back to her pre-hospital activities! Now that the activities have increased, chances are the appliance that was fit for the resident at the hospital will not work with activity.

Most of the appliance manufacturers offer samples for just this reason. Start out by looking at the back of the bag where it adheres to get an idea of where the leak occurs. Have the person sit, not lay or stand. Sitting sometimes causes creases, or pouching, to occur on the appliance.

You can get a flashlight to take a good look at what is happening when the resident sits. Remember paste is really not paste; think of it as caulk, keeping a window or pipe from leaking.

Using more will not stop the appliance from leaking. Paste is used if the skin has a rough area, as it will fill in nooks and crannies.

Also, cutting an appliance hole bigger is not better. Cutting the hole bigger will only irritate the skin being exposed to the waste. Like a psychotropic drug, remember to start low. Go slow with making changes to the products you are using.

Don’t change everyone at once, as you may only need a small change, and changing everything could make the matter worse, not better. Most of the larger appliance companies have blog sites and wound care nurses online to help with unusual situations and concerns. Jump onto one of the blog sites — these nurses are the experts and can make all sorts of recommendations. They may need a picture of the stoma, so don’t be surprised if they ask.