Name of the Procedure:

Ostomy Pouch, Urinary; with Barrier Attached (1 Piece), each (HCPCS Code: A5071)

Summary

This procedure involves the use of a one-piece ostomy pouch with an integrated barrier for urinary diversion. It is designed for patients who have undergone urostomy, a surgical procedure to create an opening (stoma) in the abdominal wall to divert urine away from a diseased or dysfunctional bladder.

Purpose

The purpose of attaching a urinary ostomy pouch with a barrier is to safely and effectively collect urine from a stoma. It is crucial for maintaining hygiene, preventing skin irritation, and reducing the risk of infections. The goal is to enhance the quality of life for patients with urinary diversions by providing a reliable method to manage urinary output.

Indications

• Urinary bladder cancer
• Neurogenic bladder
• Congenital anomalies
• Trauma leading to bladder dysfunction
• Severe incontinence unresponsive to other treatments

Preparation

• Clean the stoma area thoroughly.
• Ensure the skin around the stoma is dry and free from any moisture or lotion.
• Measure the stoma size to ensure proper fitting of the pouch.

Procedure Description

1. Gather Materials: Ostomy pouch with an attached barrier, measuring template, adhesive remover, and skin barrier wipes.
2. Prepare the Skin: Use the adhesive remover to remove any existing pouch and clean the stoma area. Dry the skin adequately.
3. Measure and Cut: Use the measuring template to cut the barrier opening to fit the stoma.
4. Attach the Pouch: Remove the backing from the barrier and carefully apply the pouch around the stoma, ensuring it adheres securely.
5. Seal and Check: Press down firmly around the barrier to ensure no leaks. Check for proper alignment and comfort.

Tools/Equipment:

• One-piece ostomy pouch with integrated barrier
• Measuring template
• Adhesive remover and skin prep wipes

Anesthesia or Sedation: Not applicable, as this is a non-invasive procedure.

Duration

The application of the ostomy pouch typically takes around 10-15 minutes.

Setting

This procedure can be performed at home by the patient or a caregiver, or in a healthcare setting such as a clinic or hospital during follow-up appointments.

Personnel

• Ostomy care nurses
• Physicians (during initial education phase)

Risks and Complications

• Skin Irritation: May occur around the stoma if the barrier is not applied properly.
• Infections: Rare, but possible if hygiene is not maintained.
• Leaks: Improper application or fitting can lead to urine leakage.

Benefits

• Effective management of urinary output.
• Prevention of skin complications and infections.
• Enhanced comfort and quality of life.
• Protection of surrounding skin.

Recovery

• No significant recovery period.
• Regular changes of the pouch as needed (typically every 3-7 days).
• Monitor the stoma and surrounding skin for signs of irritation or infection.

Alternatives

• Two-piece ostomy systems: Benefit from easier pouch changes but can be more cumbersome.
• Intermittent catheterization: Less invasive but requires more frequent attention.
• Urine collection bags: Useful short-term but may not be as comfortable or discreet.

Patient Experience

During application, patients might experience mild discomfort but should feel no pain. After application, patients should feel secure, with reduced concerns about leaks. Pain management is typically unnecessary, and focusing on proper technique ensures maximum comfort.