Name of the Procedure:

Ostomy Pouch Change for High Output Drainable Pouch
Common names: Ostomy pouch change, Ostomy bag replacement
Technical/Medical term: Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter (HCPCS Code: A4412)

Summary

In simple terms, changing an ostomy pouch involves replacing a specialized bag that collects waste from the body through an ostomy opening in the abdomen. This specific procedure uses a high-output, drainable pouch that attaches to a barrier with a flange, which is a two-piece system without a filter.

Purpose

This procedure is designed to manage waste for individuals with high-output stomas, which may result from conditions like Crohn's disease, ulcerative colitis, or other surgical alterations of the bowel. The primary goals are to ensure efficient waste collection, manage patient comfort, and maintain the health and hygiene of the stoma site.

Indications

• High output from an ostomy stoma
• Medical conditions such as Crohn's disease, ulcerative colitis, or short bowel syndrome
• Post-surgical bowel alterations leading to ostomy creation
• Inability to use a one-piece ostomy pouch system

Preparation

• Ensure the skin around the stoma is cleaned and dried.
• Gather all necessary supplies: new pouch, barrier, adhesive remover, and cleansing wipes.
• Have a mirror and well-lit area for better visibility.
• No specific dietary or fasting requirements.

Procedure Description

1. Gather Supplies: Collect a new high-output drainable pouch, a barrier with flange, cleansing wipes, adhesive remover, and a disposal bag for the old pouch.
2. Remove Old Pouch: Gently peel off the used pouch and barrier using an adhesive remover if needed.
3. Clean Stoma Area: Clean around the stoma with warm water and a mild soap or prescribed cleaning wipes. Pat the area dry.
4. Measure and Cut New Barrier: If necessary, cut the barrier opening to fit the stoma size.
5. Attach New Barrier: Center the new barrier around the stoma and press it onto the skin to ensure good adhesion.
6. Connect Pouch to Flange: Attach the new drainable pouch to the barrier flange, ensuring a secure fit.
7. Check Seal: Ensure there are no leaks or gaps and everything is comfortably in place.
8. Dispose Old Supplies: Safely dispose of the old pouch and used wipes.

Duration

The procedure typically takes about 15-30 minutes.

Setting

The procedure is often performed at home by the patient or a caregiver. In some cases, it may be conducted in an outpatient clinic or hospital setting for instructional or complex cases.

Personnel

• Patient or caregiver
• Ostomy nurse or wound care specialist for initial training

Risks and Complications

• Skin irritation or infections at the stoma site
• Leakage due to improper attachment
• Allergic reactions to adhesive or pouch material
• Stoma trauma if handled roughly

Benefits

• Efficient waste management for high-output stomas
• Improved comfort and hygiene
• Reduced risk of skin complications around the stoma
• Better quality of life

Recovery

• Minimal to no recovery time needed
• Immediate return to daily activities
• Regular monitoring of the stoma site for any signs of irritation or infection

Alternatives

• One-piece ostomy pouch systems
• Pouches with built-in filters
• Non-drainable pouches Pros of alternatives may include a simpler attachment process (one-piece systems), odor control (pouches with filters), and more frequent changes (non-drainable pouches). However, these may not be suitable for high-output situations.

Patient Experience

During the procedure, patients may feel mild discomfort while removing the old pouch but should not experience significant pain. Cleaning the area and attaching a new pouch typically provides relief and a sense of cleanliness. For pain management, using adhesive removers and ensuring a proper fit can help minimize discomfort. Support and training from healthcare professionals offer reassurance and confidence in self-care.

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