Name of the Procedure:

Ostomy Pouch, Urinary, with Extended Wear Barrier Attached (1 piece)
Technical Term: HCPCS Code A4391

Summary

An ostomy pouch with an extended wear barrier is a medical device designed for individuals who need to divert urine from the kidneys through a surgically created opening in the abdomen, called a stoma. This specific type is a one-piece system where the pouch and the barrier are combined.

Purpose

The procedure aims to provide a reliable and comfortable method for urine collection following urinary diversion surgery. It addresses conditions like bladder cancer, severe bladder dysfunction, or traumatic injury, helping patients maintain quality of life by managing waste output.

Indications

• Bladder cancer requiring cystectomy (surgical removal of the bladder)
• Congenital abnormalities affecting the urinary tract
• Severe incontinence or bladder dysfunction
• Traumatic injury to the bladder or urinary tract
• Chronic urinary tract infections not responding to other treatments

Preparation

Typically, no special preparation is needed for the patient apart from basic stoma care. Patients may require instruction on how to properly attach and manage the ostomy pouch. Regular monitoring of stoma and surrounding skin might be required to prevent complications.

Procedure Description

1. Stoma Care: Clean the stoma and surrounding skin with water and mild soap.
2. Preparation: Ensure the skin is dry before attaching the pouch.
3. Measurement: Measure the stoma to cut the barrier fittingly.
4. Application: Remove the backing from the adhesive barrier and carefully apply it around the stoma.
5. Attachment: Press down the one-piece pouch system to secure a good seal.

Equipment involved includes the one-piece ostomy pouch with an extended wear barrier, gentle cleaning supplies, a measuring guide, and possibly adhesive remover. Generally, no anesthesia or sedation is involved for attaching the pouch.

Duration

Applying the pouch typically takes between 10 to 15 minutes.

Setting

This procedure can be performed at home, in a hospital, or in an outpatient clinic.

Personnel

Patients or caregivers can often perform this procedure with proper training. Healthcare professionals such as ostomy nurses or home health aides may assist in the initial stages.

Risks and Complications

• Skin irritation or breakdown around the stoma
• Leakage if improperly fitted
• Infection if the area isn't kept clean
• Allergic reactions to the adhesive

Management of complications typically involves consultation with healthcare providers and may require changes in stoma care products or practices.

Benefits

Provides a secure and manageable way for individuals with urinary diversion to collect urine, promoting independence and comfort. Benefits are typically realized immediately upon proper application.

Recovery

Patients can resume normal activities almost immediately after applying the new pouch. Regular stoma care and monitoring for complications are advised. Follow-up visits with healthcare providers may be necessary to ensure the stoma and surrounding skin remain healthy.

Alternatives

• Two-piece systems where the barrier and pouch are separate
• Urinary catheters
• Frequent urinal drainage

Comparatively, a one-piece system like HCPCS Code A4391 often offers more comfort and ease of use.

Patient Experience

Patients may initially feel slight discomfort during the learning phase but typically find the process straightforward with practice. Pain management isn't usually necessary, but skin protection and gentle handling are essential for comfort.