Techniques: Un-Pouchable Ostomy or Fistula Patient? R.I.S.P. Technique to the Rescue! Revise, Isolate, Skin Graft, Pouch
Click here to see the RISP poster presentation from WOCNext 2021. In some situations, the soft tissue around a fistula or ostomy makes it impossible to apply a pouch and contain effluent. The purpose of RISP (Revise, Isolate, Skin graft, Pouch) is to transition the patient to a standard, easy-to-apply ostomy appliance.
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Perineal Wound Management
Literature: New Technique to Protect Perineal Skin Grafts Without A Diverting Ostomy (2021)
Techniques: Isolate the Anus with the Fistula Funnel to Protect Perineal Burns and Wounds without a Diverting Ostomy
This downloadable diagram illustrates a new technique to allow clinicians to manage burns and wounds to the perineum and avoid surgical diversion of the fecal stream with an ileostomy or colostomy. Using the Fistula Funnel with a fecal management system for anal isolation mitigates fecal contamination and may improve outcomes for burns, wounds, and split thickness skin grafts.
Visit our "how to" post.
Feeding Fistula Patients
Literature: A Patient's Guide to Managing a Short Bowel (2016)
Request a complimentary copy of A Patient's Guide to Managing a Short Bowel by Carol Rees Parrish MS, RDN.
Enteric fistula patients frequently suffer from chronic malabsorption due to Short Bowel Syndrome (SBS). Carol's book is the seminal guide for managing SBS so that fistula patients get proper nutritional support.
Literature: The Art of Fistuloclysis: Nutritional Management of Enterocutaneous Fistulas (2010)
Tools: Short-Bowel Syndrome Medication Protocol Example for Antimotility Medications
This downloadable Short-Bowel Syndrome medication protocol example foranti-motility medications can be a helpful reference when creating your protocol.
Webinar: Slow Down: Management of the High Output Ileostomy (2020)
Webinar: Entero-cutaneous and entero-atmospheric fistulas: Have we had a paradigm shift in management? (2019)
Click here to view this webinar from the American Association for the Surgery of Trauma. Dr. Richard Miller, Chief, Division of Trauma and Surgical Critical Care at Vanderbilt Medical Center presents a comprehensive overview of enteric fistula management and makes a strong case for "feeding the gut". The webinar is part of the AAST Virtual Grand Rounds educational program.
Webinars and Videos
Webinar: Principles of Enteric Fistula Management (2021)
Click here to view this session from the 2021 Stepping Stones to Excellence in Wound Care Conference, which covers assessment and classification of the enteric fistula patient, medical management, wound care best practices and surgical revision and skin grafting. 1.0 CE credit available.
Webinar: Enteric Fistula Care: Looking Beneath the Surface to Be Successful (2021)
Click here to view this session from SAWC Spring 2021 Virtual, which covers basic to advanced care of enteric fistulas, discusses why interpretation of imaging studies is important to the wound provider, and reviews the anatomy of a fistula and surgical techniques that may be used.
Webinar: Fistula Management YouTube Video Series (2020)
View this free video series on enteric fistulas, management techniques, and application of Fistula Solution devices in patient treatment by clicking the chapters below:
Webinar: 2-part Series on Fistula Care (2020)
View the on-demand series on fistula care from the 2020 Northeast Region of the WOCN's virtual conference:
Webinar: Complex Wounds and Fistula: How to Wow ‘Em! (2020)
Click here to view this session from Wild on Wounds 2020, which covers best practices in fistula drainage containment, negative pressure wound therapy, skin management to reduce discomfort, and pouching. Management of massive soft tissue injuries such as necrotizing fasciitis and Fournier's gangrene utilizing negative pressure therapy is also covered. 1.0 CE credit available.
Webinar: Planning for an Open Abdomen: Strategies and Best Practices to Increase Efficiency and Decrease Readmissions (2020)
Click here to take this free one credit course which is designed for physicians, nurse practitioners, physician assistants, nurses, physical therapists, and other allied healthcare professionals involved in the surgical closure or prevention and management of wounds.
Webinar: Reimagine Solutions for Fistula Management: The Patient, The Fistula, The Skin! (2020)
Video: The Frank & Lizzie Show (2021)
Watch the pilot episode of The Frank & Lizzie Show highlighting the development of Fistula Solution devices. This morning talk-show style channel features clinicians and products within the wound care community.
Techniques: Isolation of Enteric Fistulas to Allow Adjacent Skin Graft Placement
This downloadable case study poster from SAWC 2020 Virtual illustrates a new technique to manage intestinal effluent during the placement of skin grafts or artificial skin substitutes onto nearby wounds. Skin grafting around enteric fistulas and ostomies may allow providers to transition patients to standard ostomy appliances.
You may also click here to hear the poster presentation.
Techniques: Application of an Elastomeric Skin Protectant in Periwound Care and the Use of Customizable Isolation Devices for Fistula Management
View the poster presentation Evaluating the Application of an Elastomeric, Advanced Skin Protectant in Periwound Care and the Use of Customizable Isolation Devices for Fistula Management from 2021 WoundCon Summer. In the cases presented, modalities for fistula isolation and stoma management were integral to recovery with special attention toward periwound care.
Techniques: Stop Pouch Attachment Leakage
Leaks can happen at the interface of a pouch appliance and Fistula Solution device. The goal is to direct all effluent into the pouch appliance with no leaks. These technique tips will help assure success.
Visit our "how-to" post.
Techniques: Belted Ostomy Pouch with Fistula Solution Devices for Difficult Perifistula
Using a belted ostomy pouch with Fistula Solution devices can be a good effluent management option in cases when perifistula creases or scars make adhesive pouching difficult or when ostomy pouches will not adhere to denuded and weeping peristomal skin.
Visit our "how-to" post.
Techniques: Contain High-output Fistula and Ostomy Effluent
Techniques: Stabilize PEG Tubes and Wound Drains with the Fistula Funnel to Reduce Insertion Site Leakage
Gastric fluid leakage or wound drainage around around medical tubes can cause skin irritation, infection, reduced healing times, and general patient discomfort. The Fistula Funnel can be used to stabilize tubes to reduce tube pressure on the insertion site and the resulting leakage.
Visit our "how-to" post.
Literature: New Compressible Barrier Devices for Enteric Fistula and Ostomy Effluent Isolation (2020)
Literature: Atlas of Critical Care Procedures (2018)
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 a standard reference for surgeons, critical care physicians, nurses and all critical care professionals who manage enteric fistulas and complex wounds.
Literature: Collapsible Enteroatmospheric Fistula Isolation Device: A Novel, Simple Solution to a Complex Problem (2015)
Literature: Novel technique for stomal isolation after extensive abdominal wall soft tissue loss (2018)
Literature: Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing (2017)
Literature: SNAP protocol for fistula care (Skin and Sepsis, Nutrition, definition of fistula Anatomy, and proposing a Procedure to address the fistula)
Literature: Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study (2016)
Literature: Enterocutaneous fistula after emergency general surgery: Mortality, readmission, and financial burden (2020)
Literature: Long-Term Teduglutide for the Treatment of Patients With Intestinal Failure Associated With Short Bowel Syndrome (2016)
Tools: CeDAR App
Download the free CeDAR app to facilitate conversations with patients about their fistula repair surgery risk profile. 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.