Name of the Procedure:

Common Name(s): Ostomy Pouch Change
Technical Term: Ostomy Pouch, Drainable; for Use on Barrier with Flange (2 Piece System), each (HCPCS Code A5063)

Summary

An ostomy pouch change involves replacing a used or full ostomy pouch with a new one. This type of pouch is specifically attachable to a barrier with a flange, making it part of a two-piece ostomy system. These pouches are designed to be drainable and are commonly used by individuals who have undergone surgeries that redirect bodily waste through an artificial opening (stoma) on the abdomen.

Purpose

This procedure addresses the need for clean and effective waste management following surgeries like colostomies or ileostomies, where waste exits the body through a stoma.

Goals/Outcomes:

• Maintain hygiene and prevent skin irritation around the stoma
• Reduce the risk of infection
• Improve comfort and quality of life by managing waste discretely

Indications

Conditions:

• Colostomy
• Ileostomy
• Urostomy

Patient Criteria:

• Patients with an existing stoma from gastrointestinal or urinary surgery
• Patients needing a two-piece system with a drainable pouch for ease of management

Preparation

• Clean and prepare the stomal area with water and mild soap, avoiding any harsh chemicals.
• Gather necessary supplies: new ostomy pouch, barrier with flange, stoma measuring guide, ostomy scissors, adhesive remover wipes, and skin barrier wipes.
• Ensure hands are thoroughly washed and sanitized.

Procedure Description

1. Removal of the Old Pouch:

   • Gently peel off the old pouch from the barrier.
   • Use adhesive remover wipes if necessary to ease the process.

2. Cleaning the Stoma and Surrounding Skin:

   • Cleanse the stoma and the surrounding area with warm water and mild soap.
   • Pat the area dry gently with a clean towel.

3. Preparation of the Barrier:

   • Measure the stoma using a stoma measuring guide to cut the new barrier to the correct size.
   • Cut the barrier with ostomy scissors, ensuring the hole fits snugly around the stoma.

4. Application of the Barrier:

   • Remove the backing from the barrier and place it carefully around the stoma.
   • Press firmly to ensure adhesion to the skin.

5. Attachment of the New Pouch:

   • Attach the new drainable pouch to the flange on the barrier.
   • Ensure a secure connection by pressing around the flange to click the pouch into place.

Duration

This procedure typically takes 15-30 minutes.

Setting

This procedure can be performed at home, in a hospital, outpatient clinic, or long-term care facility.

Personnel

• If performed at home: The patient or a caregiver
• In a clinic or hospital setting: Stoma care nurse or healthcare provider

Risks and Complications

• Common Risks: Skin irritation, minor bleeding, discomfort during application
• Rare Risks: Infection, significant bleeding if the stoma is damaged, pouch leakage

Management: Address skin irritation with proper skincare; seek medical advice if infections or significant issues occur.

Benefits

• Effective waste management with minimal odor
• Reduced risk of skin complications due to frequent changes
• Enhanced comfort and improved hygiene
• Immediate benefits experienced with each successful pouch change

Recovery

• Follow regular pouch change schedules to maintain hygiene.
• Keep the stoma and surrounding area clean and dry.
• Adhere to any additional care instructions from healthcare providers.
• Attend scheduled follow-up appointments for stoma health monitoring.

Alternatives

• One-Piece Ostomy Systems: Easier application but less flexibility in pouch changes.
• Closed-end Pouches: Suitable for infrequent changes but less convenient for active lifestyles.

Pros and Cons:

• Two-piece with drainable pouches: Flexibility, efficient, suitable for frequent changes.
• Alternatives: May offer less flexibility and convenience but simpler application.

Patient Experience

• During the Procedure: Patients might feel slight discomfort during cleaning and removal of the old pouch.
• After the Procedure: Relief from replaced and cleaned pouches, increased comfort and confidence in waste management.

Pain Management:

• Generally not painful; careful and gentle handling is necessary.
• Over-the-counter pain relief may be used if minor discomfort occurs.

Comfort Measures:

• Use of adhesive remover wipes and stoma powder can enhance comfort during the procedure.

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