Name of the Procedure:

Ostomy Skin Barrier, with Flange (Solid, Flexible, or Accordion), Without Built-In Convexity, 4 x 4 Inches or Smaller (A4414)

Common name(s): Ostomy skin barrier, flange-based ostomy barrier, stoma wafer
Technical/Medical terms: Ostomy skin barrier, ostomy appliance, flange-based barrier system

Summary

An ostomy skin barrier with a flange is a device used by individuals with a stoma—an artificial opening created to divert waste outside the body. This type of barrier protects the skin surrounding the stoma and helps in securing the ostomy pouch in place without causing skin irritation.

Purpose

The primary purpose of this device is to:

• Protect peristomal skin from irritation and damage caused by stoma output.
• Provide a secure attachment point for the ostomy pouch
• Create a comfortable seal that prevents leakage.

Indications

An ostomy skin barrier is indicated for patients who have:

• A colostomy, ileostomy, or urostomy.
• Peristomal skin that requires protection from stoma output.
• Need for a flexible flange for better adaptability and comfort.

Preparation

• Ensure the skin around the stoma is clean and dry.
• Measure the stoma to cut the barrier to the correct size, if it is a cut-to-fit type.
• Verify with healthcare providers if changes in medication or diet are needed before application.
• Routine assessment of skin integrity may be performed.

Procedure Description

1. Clean and dry the area around the stoma.
2. Measure the stoma and cut the opening in the skin barrier to appropriate size, if necessary.
3. Peel off the backing to expose the adhesive surface of the barrier.
4. Center and apply the barrier around the stoma, pressing gently to ensure a secure seal.
5. Attach the ostomy pouch to the flange on the barrier.
6. Inspect the attachment for any gaps or leakage points.

Tools, Equipment, or Technology Used:

• Adhesive skin barrier with flange
• Scissors (for cut-to-fit barriers)
• Ostomy pouch

Anesthesia or Sedation Details:

• Not applicable; the procedure is painless and performed without anesthesia.

Duration

Application typically takes around 15-30 minutes.

Setting

The procedure is usually performed at home by the patient or a caregiver. Initial training and fitting might be done in a healthcare setting, such as a hospital or outpatient clinic.

Personnel

• Ostomy care nurse or healthcare provider for initial training
• Patient or caregiver for subsequent applications at home

Risks and Complications

• Skin irritation or allergic reaction to adhesive
• Leakage or improper sealing
• Potential skin damage from frequent barrier changes

Benefits

• Protects the peristomal skin from irritation and excoriation.
• Allows for a secure attachment of the ostomy pouch.
• Enhances comfort and confidence for individuals living with a stoma.

Recovery

No recovery time is needed. Immediate resumption of daily activities is possible, but:

• Regular inspection of the stoma and surrounding skin is important.
• Change the barrier as per manufacturer's guidelines or healthcare professional's advice.
• Follow-up appointments may be needed to address any issues.

Alternatives

• One-piece ostomy systems where the skin barrier is integrated with the pouch.
• Convex skin barriers if the stoma requires additional support to protrude.
• Barrier rings or paste for additional sealing.

Pros and Cons:

• Pros: Flexibility and comfort, customizable fit
• Cons: May require more frequent changes than integrated systems

Patient Experience

Patients might feel relief from skin irritation and enhanced comfort. Application may initially seem complex but becomes easier with practice. Pain is minimal, but some discomfort during the learning phase is expected. Continuous support from healthcare providers can improve confidence and skill.

Pain Management and Comfort Measures:

• Proper skincare routines can prevent and alleviate pain.
• Use of barrier rings, powders, or other skin-protective products as recommended by healthcare providers.