hygh‑tec^® basic‑plus in practice

Frequently asked questions about hygh‑tec^® basic‑plus

• Application

  
  When can hygh-tec^® basic-plus be used?
  The special sealing performance of hygh-tec^® basic-plus makes it possible to keep stools flowable and drainable for as long as the patient's particular treatment situation requires by modifying the stool consistency accordingly.

  Flowable stool can thus become an important part of higher-level therapeutic planning that is crucial for the patient's outcome.

  
  How is hyghtec^® basic-plus created and maintained?
  How does hygh-tec work? (PDF for download, poster)

• Function

  
  How do I set up continuously flowable stool in the patient?
  In order to keep stool continuously flowable and thus drainable, the patient's existing oral stool modification regimen can be adapted accordingly by the attending physician. Oral stool modification is routinely prescribed for the majority of ICU patients to prevent constipation.
  
  

  What does the low-pressure performance of hygh-tec make possible?
  The anchoring and sealing balloon body from hygh-tec consists of a very thin-walled but dimensionally stable soft foil. It is already shaped to its working size during production, but is only partially filled in the patient's rectum. The balloon lies against the rectum and the anus in a slack fold. The wall of the balloon remains tensionless and does not expand. The filling pressure of the balloon in the rectum corresponds approximately to the respective rectal pressure. If the balloon is filled correctly, the risk of pressure-related damage to the adjacent tissues can be minimised.
  
  

  Why is hygh-tec filled with air and not water?
  The wall of the balloon body is very thin, but very dimensionally stable. Under tensile or compressive load, the balloon does not break out of its anchoring and sealing shape, which was specified during manufacture. It can therefore be filled with compressible air instead of incompressible water.
  
  

  Why is the hygh-tec balloon so exceptionally thin?
  Since the balloon body lies against the rectum and anus in a slack fold, the use of thick-walled materials would cause coarse folds to form, allowing bowel contents to drain. Thin-walled balloon foils are able to provide sufficient sealing even when folded without tension.
  
  

  Is the drainage head placed in the rectum and anus too stiff?
  The head unit of the drainage consists of an elastic shaft tube that supports the dumbbell-shaped balloon body. The transanal positioned shaft tube folds radially in the anal canal when the sphincter muscle is in normal tone. When the tube is folded, its radial straightening, elastic effect diminishes. The anal apparatus is not damaged by the folded tube. If the sheath dislocates from its transanal position into the rectum and collides with the intestinal wall, it collapses along its length like a crumple zone.
  
  

  Is hygh-tec also tolerated by awake patients?
  The drainage head from hygh-tec is made of lightweight materials. It is filled with air and placed slackly in the body without tension. Due to its ability to elastically deform, it adapts to the motility of the anus and the patient's movements largely without irritation.
  
  

  Can patients be mobilised with hygh-tec?
  Patients can be placed in a sitting and also in a standing position with hygh-tec. Regular checking of the transanal position is crucial for maintaining the sealing performance. The yellow positioning ring must be visible in front of the anus.
  
  

  Does the product damage the anal sphincter?
  Erosion of the anal mucosa is largely avoided by the coaxial design of the transanal segment of the drainage head. The outer film layer lies continuously against the anal mucosa and seals the anal canal in a tamponade manner. Residual stool is thus displaced from the anal canal and cannot have an irritating effect. The inner, stool-diverting tubular layer is protectively enclosed by the outer film layer, which in turn prevents direct mechanical irritation of the mucous membrane.
  
  After prolonged applications of hygh-tec over several weeks, the anal apparatus may need one to two days until the closure function is fully established.
  
  

  Why does hygh-tec have to be emptied and refilled at intervals of 3 days?
  The wall of the hygh-tec balloon body is reliably gas-tight. However, the sealing valves used in the product do not provide a permanently reliable sealing performance. Therefore, to maintain the filling volume of 85 ml of air required for anchoring and sealing, the drainage head should be completely emptied and refilled at 3-day intervals.
  
  

  How can you avoid odours from the system?
  The wall of the stool-diverting tube that connects the drainage head to the collection bag is made entirely of PVC. Although PVC offers a certain barrier performance with regard to the release of stool odour, the system must still be cleaned of odour-forming deposits in the stool-diverting lumen at 8-hour intervals by a cleansing rinse with approx. 150 ml of water.
  
  

• Risks

  
  Overfilling the balloon
  The balloon of the drainage head must not be filled with more than 85 ml of air. If this filling quantity is exceeded, the wall of the balloon changes from the desired tensionless flaccid state to a stretched state, whereby it continuously transmits the respective filling pressure to the rectum and can thus cause pressure-related damage to the structures adjacent to the balloon.

  Furthermore, at a certain level of filling, partial or complete collapse of the stool-diverting tube inside the balloon occurs, which can cause stool to accumulate in the patient's ampoule, resulting in stool overflowing the drainage head.

  
  Pressure-related damage to the rectum due to "post-blockage" of the balloon
  The sealing performance of hygh-tec cannot be improved by increasing the filling volume. Overfilling the balloon can lead to the development of pressure damage and stool accumulation. If stool leaks from the anus while the drainage is in place, the balloon must first be completely deflated and then refilled with 85 ml of air.

  
  Accidental injection of fluid into the balloon
  The port for the supply of irrigation and irrigation fluid is marked accordingly. Injecting fluid into the filling line of the drainage head must be avoided at all costs because of the risk of pressure-related lesions developing. To detect accidental injection of fluid into the balloon body, the preanal portion of the balloon protruding from the anus should be manually palpated and assessed by the user at 8-hour intervals. If the inflation pressure appears too high, the balloon must be completely deflated and then refilled.

  
  Pressure-related damage to the rectum
  In critically ill patients, pressure-related damage to the rectum and anus cannot be excluded. Depending on the respective course of the disease, the treating physician must critically consider the implementation of continuous stool diversion during the course of treatment. Particularly in patients with septic circulation, attention must be paid to clinical signs of pressure-related lesions. In many cases, these are manifested by the development of bleeding ulcerations of the rectal or anal mucosa.

• Benefit

  
  Dry, contamination-free perianal skin status
  hygh-tec^® basic-plus enables a consistently dry skin status during the course of a stool discharge. The resulting application benefit is not limited to obvious nursing and hygienic advantages, but can be integrated into the therapeutic planning and offer significant advantages in the course of treatment.

  For example, sacral or perianal skin defects can heal faster by avoiding recurrent soiling of dressings and wound surfaces through reliably closed, sphincter-synchronised stool drainage. Unstable patients in a minimal handling situation or patients cannulated in the groin can be kept dry and continuously maintainable by appropriate stool modification and drainage.

  
  Mobilisation of patients
  Patients can be moved from a lying to a sitting position with hygh-tec^® basic-plus. Sitting in a chair is also possible with hygh-tec. The adaptive seal of the anus, which follows the patient's movements, also makes it possible to bring patients into a standing body position and to let them walk. Regular control of the correct transanal position of hygh-tec is crucial for the effectiveness of the seal. hygh-tec is usually perceived by awake, oriented patients as minimally irritating and easy to wear.

  
  Reduction of cleaning effort
  To enable smooth, efficient care, care processes must be as stable and calculable as possible. Every avoidable cleaning measure on the patient contributes to this. If the nursing teams are instructed in the system in a consistent manner, the cleaning effort caused by leaks can be minimised to a very small extent, which is crucial for optimal care logistics.

  
  Reduction of contamination with stool germs
  hygh-tec wants to offer users an objective reference point for hygienic work on patients. This consists of avoiding visible contamination by excretions and secretions, both of the patient and of the immediate and wider care environment. The goal is ambitious, but achievable on the basis of optimised sealing closure and access systems.

  With its "Contamination Containment" platform, hygh-tec is developing an overarching device concept that goes beyond stool care to include urine diversion and the management of gastric and pharyngeal secretions.