Insights

Stabilize PEG Tubes and Wound Drains to Reduce Insertion Site Leakage

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

peg 3

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.

PEG tube cutting

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.

Funnel 4 placed

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.

Funnel 5 placed

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.

Washington D.C. Symposium: Innovative Options for Complex Wounds and Fistula Management

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.

Florida Enteric Fistula Management Hands-on Workshop

Kersten Reider BSN, RN, CWOCN, will be conducting a hands-on enteric fistula management workshop at the 2019 Florida Association of Enterostomal Therapists Conference in Gainsville, Florida. The workshop begins at 4:30 PM on Friday, May 31st in the Hilton University of Florida Conference Center.

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.

2018 FAET Enteric Fistula Workshop

SAWC Spring 2019 – Surviving an Enteric Fistula: The Reality for the Patient and Care Providers

Mary Anne Obst, Complex Abdomen Specialist at Regions Hospital in St. Paul, Minnesota, will present “Surviving an Enteric Fistula: The Reality for the Patient and Care Providers” at SAWC Spring 2019. The presentation is Session 22 on May 9th at 9:15 AM.

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.

Visit the SAWC Spring 2019 website to see the full conference agenda.

Challenging Scenarios and Fistulas at the AWR Conference

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.

Recommended Enteric Fistula Reading: 2018 Atlas of Critical Care Procedures

Find excellent guidance on the Local Management of Enteroatmospheric Fistulae in Chapter 34 of the Atlas of Critical Care Procedures, Editors: Demetrios Demetriades, Kenji Inaba, and Philip D. Lumb.

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.