Name of the Procedure:

Ostomy Pouch Application
Common name(s): Urinary Ostomy Pouch
Technical term: Urinary Ostomy Pouch with Extended Wear Barrier and Faucet-type Tap with Valve (HCPCS Code A4428)

Summary

An ostomy pouch is a medical device used by individuals who have had urinary bladder diversions. The pouch is attached to the body through a barrier and collects urine from a surgically created opening in the abdomen. This specific type of pouch features an extended wear barrier and a faucet-type tap with a valve for easy urine drainage.

Purpose

This device addresses the needs of patients who have undergone a urostomy, a type of surgery that creates an opening for urine to leave the body. The goals are to collect urine efficiently, minimize leakages, and provide comfort and convenience for the patient.

Indications

• Patients with conditions such as bladder cancer, neurogenic bladder, chronic bladder infection, or severe trauma to the bladder.
• Individuals who have undergone urostomy surgery and require a reliable method to manage urinary output.

Preparation

• Patients may need to clean the abdominal area thoroughly.
• No specific fasting or medication adjustments are typically required.
• A proper fitting and skin assessment by a healthcare provider are essential before device application.

Procedure Description

1. Preparation: Ensure the abdominal skin where the pouch will adhere is clean and dry.
2. Sizing: Determine the appropriate size of the barrier opening to fit the stoma.
3. Barrier Application: Remove the protective backing and apply the extended wear barrier around the stoma.
4. Pouch Attachment: Secure the pouch to the barrier. Ensure the faucet-type tap with a valve is accessible for easy drainage.
5. Checking Fit: Smooth out wrinkles and check for any gaps to prevent leaks.

Duration

The initial fitting and application typically take about 15-30 minutes. Daily maintenance involves regular emptying and occasional changing of the pouch, usually every 3-5 days.

Setting

This procedure can be performed in a variety of settings, including hospitals, outpatient clinics, and at home.

Personnel

Typically performed or supervised by a:

• Ostomy nurse
• Urologist
• Specialized healthcare provider

Risks and Complications

• Skin irritation or infection at the stoma site.
• Leakage from an improperly fitted pouch.
• Mechanical failure of the faucet-type tap.

Benefits

• Effective management of urinary output.
• Increased comfort and convenience due to the faucet-type tap.
• Extended wear barrier reduces the frequency of changes.

Recovery

• Post-application care involves regular monitoring of the stoma and surrounding skin.
• Patients should follow instructions for emptying and changing the pouch.
• Follow-up appointments may be scheduled to ensure proper fit and function.

Alternatives

• Two-piece systems (separate barrier and pouch).
• Non-valved pouches.
• Continence devices or catheters.

Pros of HCPCS A4428:

• All-in-one system simplifies management.
• Extended wear barrier offers added durability.
• Faucet-type tap provides easier urine drainage.

Cons:

• Initial learning curve for proper application.
• May require specific healthcare consultations.

Patient Experience

• Initial discomfort or apprehension that typically improves with familiarity.
• Regular emptying of the pouch is required to avoid overfilling.
• Pain management is generally unnecessary, but skin care is crucial for comfort.

Comfort measures include ensuring a snug fit, using skin protectant barriers, and maintaining good hygiene practices to prevent infection.