New Learnings

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: 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:

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.

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.

Feeding Fistula Patients

Webinar: High-Output Management (2020)

View the on-demand session High Output Ileostomy: Preventing Acute Kidney Injury from the 2020 Northeast Region of the WOCN's virtual conference.

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 for anti-motility medications can be a helpful reference when creating your protocol.

Video:  Nutritionist Interview (2020)

Meet a fistula team nutritionist and learn her approach to assessing fistula patients and Short Bowel Syndrome (SBS) patient management.

Webinar: Slow Down: Management of the High Output Ileostomy (2020)

Click here to view this webinar from the Wound Ostomy and Continence Nurses Society which covers management of complications associated with high output ileostomies and fistulas.

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: Team Management of Enteroatmospheric Fistulas (2020)

Click here to view this session from SAWC 2020 Virtual, which demonstrates a team approach to fistula patient care during the journey to surgical revision and unique methods for fistula effluent management including pouching techniques and negative pressure with isolation.

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: Abdominal Wall Management (2020)

Click here to take this one credit AASPA course emphasizing the team approach to difficult patient management.

Webinar: Reimagine Solutions for Fistula Management: The Patient, The Fistula, The Skin! (2020)

Click here to view this session from WOCNext 2020 Reimagined, which provides solutions for fistula management with primary focus on effluent containment and perifistular skin protection.

Webinar: Creative Management of Traumatic Soft Tissue Injuries (2019)

Click here to view this free recorded webinar covering a wide array of challenging wounds including a fistula case treated using an Isolator Strip.  Presented by Mr. Ibby Younis, MBBCh, MRCS (Eng), MSc, FRCS (Plast), this intense program is focused on using instillation therapy to address a variety of complex wounds and optimize healing outcomes.

Webinar:  Passing the Pinch Test - Are you ready?  Comprehensive Management of Digestive Tract Fistulas (2018)

Click here to view this free recorded webinar to increase your knowledge of enteric fistulas and their management.  This program will give you practical insights into assessing the patient with an enteric fistula and the medical, surgical, and wound care strategies that can help optimize patient outcomes.

Webinar:  Entero-atmospheric Fistulas: Prevention and Management (2017)

Click here to view this free recorded webinar by Demetrios Demetriades, M.D., Ph.D., FACS.

Videos: Fistula Solution YouTube Channel

Find example device application techniques on the Fistula Solution YouTube channel.

Techniques

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:  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.

Techniques:  Contain High-output Fistula and Ostomy Effluent

Managing effluent from a high-output fistula or ostomy can be a challenge.  This technique can be helpful for managing high volumes of effluent.

Visit our "how-to" post.

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

Literature: New Compressible Barrier Devices for Enteric Fistula and Ostomy Effluent Isolation (2020)

Literature: Long-Term Teduglutide for the Treatment of Patients With Intestinal Failure Associated With Short Bowel Syndrome (2016)

Literature: “Floating” stoma en enteroatmosferische fistels: een uitdaging! (2020)

Read the Dutch Journal of Surgery article: “Floating” stoma en enteroatmosferische fistels: een uitdaging!

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)

Read the Journal of Wound, Ostomy and Continence Nursing article: Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing

Literature: SNAP protocol for fistula care (Skin and Sepsis, Nutrition, definition of fistula Anatomy, and proposing a Procedure to address the fistula)

snap wide

Read the Clinics in Colon and Rectal Surgery article: Management of Enterocutaneous Fistulas  (2004)

Read the Clinics in Colon and Rectal Surgery article: Enterocutaneous Fistula: Proven Strategies and Updates  (2016)

Literature:  Enteric Fistulas: Principles of Management (2009)

Read the Journal of the American College of Surgeons article: Enteric Fistulas: Principles of Management

Literature:  Management of Enterocutaneous Fistulas (2011)

Read the Surgical Clinics article:  Management of Enterocutaneous Fistulas

Literature: Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study (2016)

Tools

Tools:  Fistula Dressing Change Checklist

This downloadable Pre-Dressing Application/Change Checklist can be a helpful reference when creating your protocol.

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.

Tools:  thumbroll App

Download the free thumbroll app and go to the Enteroatmospheric Fistula Wound Management module in the General Surgery section for detailed photographic instructions for using the Wound Crown.

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.  Roll through content at your pace and see each step of the process.