Skin health for laryngectomized patients
Heat and Moisture Exchangers and their attachment devices are important medical devices for pulmonary and voice rehabilitation after total laryngectomy. Their positive impact is evident, particularly when adhering to HME use(1,2). Adherence to HME use and efficiency of tracheoesophageal voice production can be challenged by medical adhesive-related skin injuries (MARSI) and peristomal Skin Complications(3).
Why is this important to me as a health care provider in the laryngectomy field?
Understanding of the skin and of factors that influence the skin in general and peristomal skin after total laryngectomy in particular helps identify patients that may be at risk for the development of MARSI. Availability of new peristomal adhesives based on modern adhesive materials and technology, careful adhesive selection and appropriate application and removal techniques can also help prevent MARSI and maintain the integrity of the peristomal skin (3). Healthy peristomal skin forms the foundation for adherent HME use and an airtight seal for efficient tracheoesophageal speech.
Skin Assessment, Intervention & Monitoring
The Skin Assessment, Intervention & Monitoring Guide (AIM Guide) was developed to provide a common language to describe skin complications seen under the adhesive baseplate and to provide practical care guidance to help promote early intervention and minimize Medical Adhesive-Related Injuries (MARSI). Prevention is better than cure; AIM to keep the skin healthy and intact.
- Identify patients at risk: Know intrinsic and extrinsic risk factors for MARSI and identify patients who are at risk. Develop a good adhesive routine and closely monitor
- Use the most skin-friendly adhesive option: A hydrocolloid may be suitable for general use, depending on its ability to withstand phonatory pressure in tracheoesophageal speech speakers
- Develop a good adhesive routinese the most skin-friendly adhesive option: Develop a routine that allows for planned adhesive changes so that adequate time is available. Identify the need for hydrogel adhesive use for skin care and recovery, developing a schedule towards prevention of MARSI.
- Apply proper application and removal technique: Know and understand state of the art for adhesive removal and application.
- Make intact peristomal skin a priority: Monitor and record skin condition, detect problems early and refer to a dermatologist if required
Learn more about peristomal skin health in laryngectomized patients
Access the whitepaper Healthy peristomal skin: a foundation for successful voice and pulmonary rehabilitation for more preventable causes of MARSI and possible solutions together with the Skin AIM-guide. With this guide you support patients to help maintain healthy peristomal skin and minimize MARSI.
Please fill in the form below and an e-mail with the whitepaper and the Skin AIM-guide will be sent you.
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CareTips - Prevention of adhesive related skin injuries
As indicated in the Skin Whitepaper, Healthy peristomal skin: a foundation for successful voice and pulmonary rehabilitation a number of preventable causes of MARSI have been identified (i.e. improper choice of adhesive, improper application technique, leaving non-permeable adhesives on too long, improper removal technique, repeated adhesive changes, touching the adhesive layer prior to application).
In this CareTips, each of these causes is addressed together with possible solutions to consider in general and for total laryngectomy patients in particular. In addition, some causes for MARSI that are specific to total laryngectomy patients are addressed here as well: Speaking too soon after application, mucus trapping underneath adhesive, excessive speaking pressure, not supporting the adhesive when removing the HME.
Download your copy of the CareTips on how to maintain good skin health in total laryngectomy patients here.
CareTips - Skin irritation and tips to get the adhesive to stay on all day
This video includes tips to get the adhesive to stay on all day. It also has tips and tricks for getting a good seal, to minimize skin irritation and what available for sensitive or irritated skin.
How do I know what adhesive to suggest for my patient?
This video covers the features and benefits of different adhesive materials such as hydrocolloid, hydrogel and acrylic. It helps us understand how the material interacts with the skin as well as how it affects application and removal techniques.
Bibliography
1Bien S, Okla S, van As-Brooks CJ, Ackerstaff AH. The effect of a Heat and Moisture Exchanger (Provox HME) on pulmonary protection after total laryngectomy: a randomized controlled study. Eur Arch Otorhinolaryngol. 2010;267(3):429-35.
2Parrilla C, Minni A, Bogaardt H, Macri GF, Battista M, Roukos R, et al. Pulmonary Rehabilitation After Total Laryngectomy: A Multicenter Time-Series Clinical Trial Evaluating the Provox XtraHME in HME-Naive Patients. Ann Otol Rhinol Laryngol. 2015;124(9):706-13.
3Atos Medical, Whitepaper: Healthy peristomal skin: a foundation for successful voice and pulmonary rehabilitation, 2023.