Name of the Procedure:

• Common names: Ostomy skin barrier with flange
• Medical term: Ostomy skin barrier (solid, flexible, or accordion) larger than 4 x 4 inches, without built-in convexity (HCPCS A4415)

Summary

An ostomy skin barrier with a flange is a medical device used to protect the skin around a stoma and secure a collection pouch. It is larger than 4 x 4 inches and does not include built-in convexity, which means it lies flat against the skin.

Purpose

• Medical conditions/problems it addresses: Used for patients with a stoma to manage waste securely.
• Goals/expected outcomes: To prevent skin irritation and ensure the ostomy pouch stays in place, reducing discomfort and infection risk.

Indications

• Specific symptoms/conditions: Patients with any type of ostomy (e.g., colostomy, ileostomy, urostomy).
• Patient criteria: Those requiring a larger skin barrier without convexity.

Preparation

• Pre-procedure instructions: Ensure the peristomal skin (around the stoma) is clean and dry before the application.
• Diagnostic tests: Generally, no specific pre-procedure tests required, but routine stoma care evaluation may be recommended.

Procedure Description

1. Skin Preparation: Clean the peristomal area with mild soap and water, then dry thoroughly.
2. Sizing the Stoma: Measure the stoma to ensure the correct size of the skin barrier opening.
3. Cutting the Barrier: Using scissors, cut the barrier opening to match the stoma size.
4. Applying the Barrier: Remove the protective backing from the barrier and gently press it around the stoma.
5. Securing the Pouch: Attach the ostomy pouch to the flange on the skin barrier.

• Tools/Equipment:

  • Ostomy skin barrier with flange
  • Stoma measuring guide
  • Scissors
  • Ostomy pouch

• Anesthesia or sedation: Not required.

Duration

Applying the ostomy skin barrier usually takes about 10-15 minutes.

Setting

Typically performed in the patient's home or outpatient clinic. Nurses or caregivers may assist initially.

Personnel

• Healthcare professionals involved: Nurses, particularly ostomy care nurses, may assist the patient in learning the procedure.

Risks and Complications

• Common risks: Skin irritation, leakage, adhesive allergies.
• Rare risks: Severe skin breakdown, infection.
• Management: Proper hygiene, regular monitoring, and adjustments by healthcare providers.

Benefits

• Expected benefits: Enhanced skin protection, secure fitting, reduced leakage, improved comfort.
• Realization of benefits: Typically immediate, as the barrier provides an instant fit and protection.

Recovery

• Post-procedure care: Regular cleaning and monitoring of the peristomal skin.
• Recovery time: Not applicable; patients continue with regular ostomy care.
• Restrictions/Follow-up: Regular follow-up with healthcare providers to review stoma and skin health.

Alternatives

• Other options: Pre-cut skin barriers, barriers with built-in convexity, different sizes and types of barriers.
• Pros and cons: Customization with the described barrier vs. ease of use with pre-cut or convex barriers.

Patient Experience

• During the procedure: Minimal discomfort during application.
• After the procedure: Generally little to no pain; some initial adjustments may be required for comfort. Use of skin barrier powders and adhesive removers can further enhance comfort.