Name of the Procedure:

Ostomy Skin Barrier, with Flange (solid, flexible, or accordion), Extended Wear, Without Built-in Convexity, Larger than 4 x 4 Inches, Each (A4410)

Common Names: Ostomy wafer, ostomy barrier, flange Technical/Medical Term: Ostomy skin barrier with flange, extended wear

Summary

The ostomy skin barrier with flange is a medical device used to protect the skin around a stoma. It acts as a secure attachment for an ostomy pouch, preventing leakage and skin irritation. This particular model is designed for extended wear and does not have built-in convexity, making it suitable for larger stomas.

Purpose

Medical Conditions: Used by patients with a stoma due to conditions such as colorectal cancer, inflammatory bowel disease, diverticulitis, or traumatic injury. Goals/Outcomes: To securely attach an ostomy pouch to the stoma, protect the skin from irritation and infection, and maintain a leak-proof seal for an extended period.

Indications

Symptoms/Conditions: Presence of a stoma requiring an ostomy pouch; this is commonly seen in patients post-colostomy, ileostomy, or urostomy. Patient Criteria: Patients needing a larger-than-normal barrier (greater than 4 x 4 inches), those who require extended wear time between changes, and those without the need for built-in convexity.

Preparation

Pre-Procedure Instructions:

• Ensure skin around the stoma is clean and dry.
• Measure the stoma size to select the appropriate barrier size. Diagnostic Tests/Assessments:
• Routine inspection of the stoma and surrounding skin.
• Periodic stoma measurement to ensure correct barrier fit.

Procedure Description

1. Clean the Area: Gently clean the peristomal skin with warm water and dry thoroughly.
2. Measure and Cut Barrier: Measure the stoma using a measuring guide and cut the barrier opening to fit snugly around it.
3. Prepare the Flange: Remove the release liner from the adhesive side of the barrier.
4. Apply the Barrier: Center the barrier over the stoma and press down firmly to ensure a good seal.
5. Attach the Pouch: Align the flange of the ostomy pouch with the flange of the barrier and press them together to lock in place.

Tools/Equipment: Measuring guide, scissors, adhesive remover (if needed), stoma barrier, ostomy pouch. Anesthesia/Sedation: Not applicable.

Duration

Application and fitting typically take about 15-30 minutes.

Setting

Performed in various settings including:

• Home care
• Outpatient clinic
• Hospital setting

Personnel

Generally managed by:

• Ostomy nurses
• Gastroenterologists (if in a clinical setting)
• Trained caregivers or the patients themselves for at-home care

Risks and Complications

Common Risks: Skin irritation, leakage, allergic reactions to adhesive. Possible Complications:

• Skin breakdown or infection around the stoma.
• Poor fit leading to stoma injury or pouch detachment.

Benefits

Expected Benefits: Secure attachment of ostomy pouch, extended wear time, protection of peristomal skin. Realization Time: Immediate benefits in terms of secure fit and leak prevention, with ongoing benefits related to skin protection.

Recovery

Post-Procedure Care: Regular inspection of the stoma and skin, proper hygiene. Recovery Time: Immediate return to daily activities after application, with recommended periodic changes based on wear time (usually every 3-7 days). Follow-Up: Routine follow-ups with a healthcare provider to ensure proper stoma care and barrier fit.

Alternatives

Other Options:

• Ostomy barriers with built-in convexity.
• Different types or sizes of ostomy barriers. Pros and Cons:
• Convex barriers provide additional support for retracted stomas but may be uncomfortable.
• Smaller barriers might not cover and protect adequately if the stoma size is large.

Patient Experience

During the Procedure: The patient may feel mild pressure around the stoma as the barrier is applied. After the Procedure: Comfort levels typically increase due to secure attachment, but some initial skin sensitivity may be felt. Proper education on pain management and skin care can greatly enhance comfort and compliance.

Pain management usually involves over-the-counter pain relief if needed, and addressing skin irritation promptly with recommended products.