Name of the Procedure:

Ostomy Skin Barrier with Convexity Common name: Ostomy flange, ostomy skin barrier
Technical term: Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller (HCPCS Code: A4407)

Summary

An ostomy skin barrier is a medical device used to protect the skin around a stoma, which is an artificial opening created during surgery to allow waste to leave the body. This particular barrier includes a convex shape to better fit around the stoma and is designed for extended wear. The barrier is typically worn by individuals with colostomies, ileostomies, or urostomies.

Purpose

Ostomy skin barriers are designed to:

• Prevent skin irritation and damage around the stoma.
• Create a secure seal to prevent leaks.
• Improve comfort and confidence for the wearer.

The primary goal is to maintain skin integrity and support the functionality of the ostomy appliance.

Indications

• Patients with a stoma due to colostomy, ileostomy, or urostomy.
• Those experiencing frequent leaks or skin irritation with flat barriers.
• Individuals needing an extended-wear solution to reduce frequent changes.

Preparation

• Clean and dry the skin around the stoma.
• Measure the stoma size to select the appropriately sized barrier.

• Remove any previous barrier and inspect the skin for irritation.

  No special diagnostic tests or fasting are required.

Procedure Description

1. Clean the Stoma Area: Gently clean the area around the stoma with water and dry thoroughly.
2. Measure the Stoma: Use a stoma measuring guide to ensure the correct size is selected.
3. Prepare the Barrier: Cut the barrier opening to fit the stoma size if necessary.
4. Apply the Barrier: Remove the backing from the barrier and carefully apply it, ensuring the convexity fits snugly around the stoma to create a seal.
5. Attach the Pouch: Connect the ostomy pouch to the flange of the skin barrier.

Duration

• Preparing and applying the barrier typically takes about 15-30 minutes.

Setting

• Can be performed at home or in an outpatient clinic.

Personnel

• Ostomy nurse or healthcare provider initially; then self-care by the patient.

Risks and Complications

• Skin irritation or allergic reaction to the barrier material.
• Improper fit leading to leaks or skin damage.
• Infection around the stoma site if not properly maintained.

Benefits

• Reduces skin irritation and leakage.
• Increases wear time, reducing the need for frequent changes.
• Improves overall comfort and convenience for the patient.

Recovery

• No significant recovery period.
• Regular changes of the barrier as needed (every few days to a week).
• Follow-up with a healthcare provider if complications arise.

Alternatives

• Flat skin barriers without convexity.
• Custom-fitted ostomy appliances.
• Alternative skin protection products like barrier rings or strips.

Pros and Cons:

• Convex barriers provide a better fit for recessed or uneven stomas but might be less comfortable initially.
• Flat barriers may be more comfortable but require more frequent changes and may result in more leakage.

Patient Experience

• Patients may initially feel some discomfort as they adjust to the convex barrier.
• Regular monitoring of the stoma site is essential to manage any irritation.
• Pain is generally minimal but manageable with over-the-counter pain relief if needed.
• Improved confidence and quality of life with reduced leaks and longer wear time.