inforMED
InjuryEXG

MODERMA FLEX UROSTOMY POUCH WITH CONVEX SKIN BARRIER

Received Nov 17, 2017 · Event occurred May 8, 2017

Report 1119193-2017-00036 · MDR key 7042267

Device

Generic name

Urostomy Pouch

Model number

2969139

Catalog number

2969139

Product problems

  • Adverse Event Without Identified Device or Use Problem

Patient

64 YR

  • Pressure Sore/Ulcer
  • Pressure Sore/Ulcer

Narrative

Additional Manufacturer Narrative

A DEVICE MALFUNCTION HAS NOT BEEN ALLEGED OR DETERMINED. ADDITIONAL INFORMATION WAS RECEIVED ON NOVEMBER 16TH FROM THE CLINICAL NURSE WHO CARED FOR THE PATIENT. THE OPINION OF THE TREATING NURSE IS THAT THE PRESENCE OF CONVEXITY AGAINST THE PATIENT'S PERISTOMAL SKIN CAUSED THE PRESSURE AREA. THE USE OF CONVEXITY FOR PATIENTS WITH FLUSH OR RECEDING STOMAS IS THE STANDARD PRACTICE; HOWEVER, THE POTENTIAL EXISTS FOR PRESSURE-RELATED ISSUES THAT SHOULD BE MONITORED DURING ITS USE TO DETERMINE IF THE BENEFITS OF USING THE PRODUCT OUTWEIGH THE RISK OF EFFLUENT LEAKAGE.

Description of Event or Problem

IT WAS REPORTED THAT THE PATIENT PRESENTED TO THE HOSPITAL ON (B)(6) 2017 WITH A STAGE 2 PRESSURE INJURY NEAR HIS URINARY STOMA WHICH WAS ATTRIBUTED TO THE HOLLISTER CONVEX UROSTOMY POUCH. THE PATIENT WAS TREATED THROUGH (B)(6) 2017 WITH OVER 42 VISITS TO THE CLINIC. THE PRESSURE ULCER HAS HEALED. IT WAS NOTED BY THE CLINIC THAT THE PATIENT DID HAVE A WEIGHT GAIN WHICH IS BELIEVED TO HAVE CONTRIBUTED TO THE PRESSURE ULCER OCCURRING.