Mary Anne Obst, RN, CWON, CCRN, presents in this free recorded webinar that will increase your knowledge of enteric fistulas and their management. This informative program will give you practical insights into assessing the patient with an enteric fistula. Mary Anne will also cover the medical, surgical, and wound care strategies that can help optimize patient outcomes.
Sharing her clinical expertise as a complex abdomen specialist, Ms. Obst will outline the risk factors associated with enteric fistulas and the preventive measures that may help reduce complications. Critical factors for successful fistula management and closure will be covered. Mary Anne will also discuss specific wound care principles and the application of the "pinch test" as the gateway to surgical readiness.
The free thumbroll app has a new step-by-step training module on Enteroatmospheric Fistula Wound Management. Simply download it from the App Store or Google Play and start learning.
The fistula module is in the General Surgery section of the app. thumbroll uses real images to show how to use the Wound Crown in detailed steps, making it easily digestible. Learn at your pace as you scroll through each step of the process.
thumbroll is like a visual checklist. Content is broken down to the component steps, allowing you to just see what is necessary to learn the material.
thumbroll is a free learning tool for all medical trainees and professionals worldwide and it is available for iOS & Android.
A common mitigation approach to fecal contamination of perineal wounds and skin grafts is to create an ileostomy or colostomy. However, the Fistula Funnel can be paired with standard fecal management systems to isolate burns and wounds to the perineum without surgical redirection of the fecal stream.
This illustration depicts how the Fistula Funnel can be employed to isolate a fecal management system. The "how-to" steps to assemble the devices follow.
Click hereto see a video that demonstrates this technique.
1. Tailor the Fistula Funnel and create a skirt by cutting along the scribe line. The skirt is intended to seal and protect the perineum from fecal management system leakage.
2. Disinfect the Fistula Funnel with skin or wound cleaning solution, then pull the fecal management system through the Fistula Funnel opening.
3. Apply dressings to Fistula Funnel, ensuring the skirt around the base of the Fistula Funnel opening faces toward the anus.
4. Apply an ostomy barrier ring to the base of Fistula Funnel to help form a seal between the skin and the device.
Compress the prepared Fistula Funnel against the skin around the fecal management drain to seal and protect the perineum.
Gastric fluid leakage or wound drainage around medical tubes is an unfortunate occurrence. The leaked fluid can cause skin irritation, infection, reduced healing times, and general patient discomfort. Leakage often occurs because patient movement rubs the tube against the insertion site and widens the incision over time
The Fistula Funnel can be used to stabilize tubes and reduce tube friction on the insertion site. The "how-to" steps follow.
1. As shown, place the bottom half of the Fistula Funnel around the tube prior to tube placement if possible.
If the tube is already in place, tailor the Fistula Funnel by cutting as indicated by the dotted line so it can be placed around the tube.
2. Place a contact layer followed by a flat ostomy barrier ring on the perimeter skin. Notch the flange to allow the device to flex, then place it around the tube so that the notched flange rests on the ostomy barrier ring.
3. Fasten the Fistula Funnel to the patient by placing adhesive strips on top of the base flange. Use zip ties or tape to fasten the Fistula Funnel to the tube. The stabilized tube should stand perpendicular to the patient's body.
This technique can stabilize PEG tubes and wound drains in order to reduce tube rubbing on the insertion site and mitigate incision widening. The Fistula Funnel and companion dressings can also help seal and protect the skin from leakage when applied as shown.
Reider notes, “Enteroatmospheric fistulas (EAF) are common complications of open abdomen bowel surgery. An EAF is a devastating complication for both surgeon, clinical provider, and patient. Prior to the advent of sophisticated treatment plans, EAF’s held a large mortality rate. Traditionally, management of EAFs had involved placing large fistula management pouches over the wound to collect and contain effluent. However, at FAET we will be demonstrating more current techniques to isolate and heal fistulas.”.
Kersten is a Wound, Ostomy, Continence Nurse with Tower Health System in West Reading, Pennsylvania. She has extensive experience in managing enteric fistulas and using Fistula Solution devices. Her workshop will teach you new ways to address your fistula challenges.
Visit the FAET website to see the full conference agenda.
Mary Anne will discuss the life changing physical and emotional trauma that some patients experience when a fistula develops. The leakage, odor and skin destruction, and depression can lead to physical and emotional pain that is unbearable. Caregivers suffer as well in terms of frustration with management problems and inability to “make it better” for the patient with the condition. This session will demonstrate pouching techniques using negative pressure wound therapy to contain the drainage, skin management to reduce the discomfort, and pouching tips for keeping the patient clean, dry, and comfortable during this trying time.
The Challenging Scenarios session at the upcoming Abdominal Wall Reconstruction Conference includes hernia repair topics and a pair of exciting enteric fistula presentations. B. Todd Heniford, MD from Carolinas Medical Center Department of Surgery will present "Mesh Infection and Fistula: Surgical Management and Long-term Outcomes". Dr. Heniford will be followed by Mary Anne Obst, WOCN and Complex Abdomen Specialist at Regions Hospital, who will share "Enterocutaneous Fistula: Best Practices for Wound Management".
The presentations will be followed by questions and panel discussion including best practices in fistula management.
The 2019 Abdominal Wall Reconstruction conference will be June 6-8 at the Grand Hyatt in Washington D.C. Visit the AWR website to see the full conference agenda.
This atlas is an all-inclusive resource that describes step by step how to perform the essential bedside procedures required to provide optimal care to the critically ill patient. Detailed descriptions of these procedures, with sequential photographs depicting each critical step, provide an in depth understanding of the anatomy, critical technical steps and common pitfalls to both military and civilian trainees. For the advanced professional operator, this atlas will provide a rapid refresher of the critical steps and is an excellent teaching resource, based on the decades of collective experience accumulated by the authors. This atlas is a standard reference for surgeons, critical care physicians, nurses and all critical care professionals who manage enteric fistulas and complex wounds.