Enteric Fistula – Page 3 – Fistula Solution

Fistula Management Team at SAWC Spring 2020

It takes a village to care for fistula patients.

Experience a multidisciplinary team approach to fistula management at SAWC Spring.

Mary Anne Obst and Kristen Lindvall from the Complex Abdominal Reconstruction (CARS) team at Regions Hospital will present Team Management of Enteroatmospheric Fistulas. They will share the CARS methodology for fistula patient care during the 6 to 18 month wait time before definitive surgical treatment. They will cover wound care, nutritional support, psychosocial counsel, medical management, and surgical planning.

Belted Pouching with Fistula Solution Devices

A high-output enterocutaneous fistula or ostomy may produce two to seven liters of effluent per day which can be devastating to the skin and can cause pain, infection and emotional isolation.

Using a belted ostomy pouch with Fistula Solution devices can be a good effluent management option, particularly when:

The perifistula topography of a patients body, creases, or scars make adhesive pouching difficult, or
Ostomy pouches will not adhere to excoriated and weeping peristomal skin.

In these cases intestinal effluent can cause further irritation and wound formation of perifistula skin. To seal and protect the skin from effluent, Fistula Solution devices can be compressed around the patient’s enteric fistula or ostomy with a belted pouching system.

The following "how-to" steps illustrate the use of the Fistula Funnel in these challenging situations.

1. Tailor the Fistula Funnel by cutting along the exterior scribe line to form a skirt. The skirt will help form a good seal around the fistula or ostomy and protect the surrounding skin from effluent.

2. Check the fit of the tailored Fistula Funnel to ensure it will seal when compressed to the surface of the body.

The visible portion of the compression area is indicated by the yellow shape.

3. Center fistula or stoma in opening and compress the device. The fistula or stoma should be visible through the device opening after placement on the patient.

4. Apply a belted ostomy pouch appliance to compress the device to seal and protect skin and capture intestinal effluent.

This technique can be used to protect the skin from effluent and enable healing when other methods may not work and can dramatically improve quality of life for the patient.

High-output Fistula and Ostomy Effluent Containment

Managing effluent from a high-output fistula or ostomy can be a challenge. Even large, high-output pouches can prove insufficient when a patient puts out 5 to 10 (or more) liters of effluent daily.

Pictured is a technique for managing high volumes of effluent. A container is connected to the pouch using large bore corrugated tubing. Then, as prescribed by the provider, intermittent wall suction is applied to the container to draw effluent out of the pouch.

1. Connect and seal a suction tube near the top of a 3000 ml or other large container. Do not extend the tube more than 3 inches / 6 cm inside the container. Connect the free end of the tube to wall suction.

2. Connect and seal corrugated tubing to the top of the container. Ensure tubing is long enough to reach from the floor to the patient's pouch.

3. Fasten the top to the container and place the container on the floor near the patient.

Note that the container inlets for corrugated tubing and wall suction are spaced apart. This is so the effluent that is drawn into the container will drop to the bottom of the container and not be drawn into wall suction.

4. Connect and seal the free end of the corrugated tubing to the pouch drain.

As indicated by the healthcare provider, apply intermittent wall suction to draw excess effluent out of the pouch and through the corrugated tubing into the container.

This technique tip can help eliminate pouch clogs and effluent overfilling that can result in pouch adhesion failure and spills

The fill level of the large container should be monitored and the container can be emptied as needed. When a patient needs to move the suction tube can be disconnected from the wall so the patient can take the container with them.

Sanford Wound & Ostomy Care Conference: Advance Wound Care

Sanford Health's biennial Wound & Ostomy Care Conference is December 6, 2019 in Fargo, North Dakota. The purpose of the symposium is to increase the knowledge and competence of health care professionals related to evidence-based wound prevention and treatment, and ostomy management. The target audience includes nurses, advanced practice providers, physicians, and other interested health care professionals.

Mary Anne Obst, Complex Abdomen Specialist at Regions Hospital in St. Paul, Minnesota will present on ostomy containment and fistula and wound management while preserving peri-wound skin. She will also present a team approach to managing complex abdominal wounds and fistulas.

Click here for more information.

Virtual Grand Round – Entero-cutaneous and entero-atmospheric fistulas: Have we had a paradigm shift in management?

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.

SAWC Fall 2019: Ask a Surgeon about Fistula and Ostomy Management

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.

Help Fistula Patients Reduce Their Surgery Risk with the CeDAR App

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.

Oregon Seminar: Complex Abdominal Wounds and Fistula Nightmares

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.

Stop Pouch Attachment Leakage

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.

Free Webinar on Comprehensive Management of Digestive Tract Fistulas

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.

Click here to view the webinar.

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.