Name of the Procedure:

Convex Insert for Ostomy Accessory
Common names: Convex Insert, Ostomy Convexity
Technical/Medical term: HCPCS Code A5093

Summary

A convex insert is a medical accessory used with an ostomy appliance to provide additional support and improve the fit of the ostomy bag. It is designed to help form a better seal around the stoma, thereby reducing the risk of leaks and enhancing comfort for patients with an ostomy.

Purpose

The convex insert addresses issues like uneven or retracted stomas that make it difficult to get a good seal with a flat ostomy appliance. It aims to:

• Promote better adherence of the ostomy bag
• Reduce skin irritation by minimizing leaks
• Provide support to the peristomal skin area

Indications

• Retracted stomas
• Stomas situated within skin folds or creases
• Uneven peristomal areas that cause frequent leakage
• Patients who frequently experience leaks with a standard flat ostomy flange

Preparation

• Clean and dry the area around the stoma.
• Ensure the patient understands the application process.
• No specific diagnostic tests are required beforehand.
• No fasting or medication adjustments are typically necessary.

Procedure Description

1. Cleaning: Wash the peristomal area with mild soap and water; dry thoroughly.
2. Sizing: Measure the stoma to select the correct size of the convex insert.
3. Application: Place the convex insert inside the ostomy flange.
4. Attachment: Secure the ostomy appliance around the stoma, ensuring the convex insert maintains a snug fit against the skin.
5. Adjustment: Press gently to ensure a secure seal and complete adhesion.

Tools/Equipment: Convex insert, ostomy flange, and adhesive.
No anesthesia or sedation is involved in this procedure.

Duration

The application of the convex insert typically takes about 10-15 minutes.

Setting

The procedure can be performed in various settings:

• At home
• Outpatient clinic
• Ostomy care center

Personnel

• Ostomy nurse or wound care specialist can assist during the initial applications.
• Patients can often apply the convex insert themselves once they feel confident.

Risks and Complications

• Skin irritation or allergic reaction to the insert material
• Pressure ulcers if the insert is overly tight or misapplied
• Rarely, infection if the site is not kept clean

Benefits

• Improved seal and reduced risk of leaks
• Enhanced comfort and confidence in daily activities
• Immediate benefits in terms of better bag adherence and fewer complications like skin irritation

Recovery

• No recovery period is needed post-application.
• Monitor the peristomal skin for any signs of irritation or allergic reaction.
• Regularly change the appliance and insert as per manufacturer's recommendations.

Alternatives

• Use of standard flat or moldable ostomy wafers without a convex insert
• Custom-fitted ostomy appliances
• Surgical revision of the stoma, though this is more invasive and reserved for persistent issues

Patient Experience

Patients may experience an initial learning curve when applying the convex insert but generally find it straightforward with practice. Pain is not typical, but discomfort or pressure should be minimal and manageable. Patients often report greater peace of mind and comfort due to fewer leaks and improved fit.