The American Association for the Surgery of Trauma is hosting the virtual grand round: Entero-cutaneous and entero-atmospheric fistulas: Have we had a paradigm shift in management? The live broadcast is November 20, 2019 at 5:00 PM Eastern.
Dr. Richard Miller, Chief, Division of Trauma and Surgical Critical Care at Vanderbilt Medical Center will be presenting.
Click here for more information.
Ever wish you could ask a surgeon a question about a fistula or ostomy? Here is your chance! For example, why is this stoma flat? Can you help with this sidewall fistula? Why do we need to wait so long to repair a fistula?
Send your questions or cases for Dr. David Dries’ perspective on solutions. Selected questions and cases will be reviewed during the “Ask a Surgeon” portion of Session 13 - Fistula and Ostomy Management for the Wound Provider at the SAWC Fall conference on October 12th.
Download the free CeDAR app to facilitate conversations with patients about their fistula repair surgery risk profile. The app is available in the App Store or Google Play.
Users simply answer eight questions about themselves, including height and weight. A percentage chance of developing specific postoperative complications requiring treatment is calculated, along with the corresponding cost of this treatment. These results can then be used to discuss a patient’s risk for wound problems after surgery and what changes they can make to improve the odds for a good result.
Wound problems after surgery are the major reason for increased cost of surgery, including the added cost of other procedures, hospital stays and clinic visits. Because of their wounds, these patients often are not able to work and lose time and money because of specialty wound care, travel, clinic visits and/or hospital stays. The app predicts the risks and financial impact of wound-related problems using a mathematical equation derived from real patient data. Helping patients understand their risks can facilitate a deeper conversation about behavioral changes that will reduce the risk of wound problems.
Mary Anne Obst will present "Complex Abdominal Wounds and Fistula Nightmares: Tricks and Tips" October 19th in Medford, Oregon. The seminar is at the Advanced Wound Care Conference of the Northwest Region of the WOCN.
Mary Anne is a Complex Abdomen Specialist at Regions Hospital in St. Paul, Minnesota. She will teach participants various approaches to promote quality of life while targeting surgical repair when applicable. She will also share unique methods for managing complex abdominal wounds and enterocutaneous fistulas.
Click here for conference information.
Leaks can happen at the interface of a pouch appliance and Fistula Solution device. Usually leaks are because the pouch opening is cut too small or because of poor pouch adhesion.
The goal is to direct ALL effluent into the pouch appliance with no leaks. These technique tips will help assure success.
Click here for a detailed pouching video that demonstrates these technique tips.
1. Add a thin ostomy barrier ring to the top flange of the of the Fistula Solution device. This landing zone is where the high output ostomy pouch or wound manager will be placed.
2. Cut the opening in the high output ostomy pouch or wound manager generously. Make the opening diameter about 1 cm larger than the Fistula Solution device opening. Then place the pouch appliance on the landing zone.
3. Bridge the gap between the opening of the pouch appliance and the landing zone with another ostomy barrier ring. A barrier ring can be cut and applied in segments as shown in the image to the right.
Work the pouch appliance into the barrier rings. Have the patient lay quietly for 30 minutes or more to allow the pieces to warm up and adhere to each other.
These technique tips can help stop leaks from happening at the interface of the pouch appliance and Fistula Solution device, and ensure all effluent goes into the pouch where it belongs.
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.
For more information:
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 here to 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.
KCI An Acelity Company is sponsoring a breakfast symposium focusing on: “New Advances in Challenging Wound Care: Examining the Evidence and Discussing the Cases” at the Abdominal Wall Reconstruction Conference in Washington D.C. on June 8th. The session features presentations on new therapies from Vedra Augenstein, MD, Luis Fernandez, MD, and Mary Anne Obst, RN.
This presentation begins at 8:30 AM on June 8th at the Grand Hyatt Washington.
Register for this event at www.awrconference.com.
