Fistula Fiesta at WOW! Exploring Innovative Management Techniques for a Complex Challenge

Are you a dedicated healthcare professional seeking to expand your knowledge and skills in advanced wound care? Look no further! The Wild on Wounds (WOW) conference in Hollywood, Florida, is back with its impactful, hands-on wound care education. This year, the spotlight is on the "Fistula Fiesta" session - a unique opportunity to explore effective management techniques for the complex challenge of fistulas.

An Insightful Journey into Fistula Management

On September 16, 2023, the WOW conference will offer a comprehensive look into the management of fistulas. These challenging wounds can have a profound impact on both patients and their caregivers, making it crucial for healthcare professionals to stay informed about the latest advancements in treatment and care.

Unraveling the "Fistula Fiesta" Session

Designed specifically to address the complexities of fistulas, the "Fistula Fiesta" session will focus on the unique difficulties faced by patients and caregivers alike. Whether you're a nurse, a physical therapist, or an occupational therapist, this session will equip you with valuable insights and skills to effectively manage this intricate wound condition.

The Significance of Fistula Management

Fistulas pose significant challenges, often requiring a multidisciplinary approach to achieve the best outcomes for patients. Moreover, the psychological impact on patients and their families should not be underestimated. This session aims to illuminate the best practices in fistula management, empowering attendees to provide better care and support to their patients.

What You'll Learn

By attending the Fistula Fiesta session, you'll have the opportunity to achieve several key learning objectives, including:

  • Identifying three common types of fistulas that develop in patients.
  • Comparing different types of fistula management devices available on the market, allowing you to make informed choices tailored to your patients' unique needs.

Your Expert Guide - Emily Greenstein

Leading the Fistula Fiesta session is the experienced Emily Greenstein, APRN, CNP, CWON-AP, FACCWS, from Sanford Health in Fargo, ND. Emily's wealth of knowledge and expertise makes her the perfect guide to navigate the complexities of fistula management. With her board certifications in Wound and Ostomy Care and 14 years of experience, she is dedicated to advancing wound care practices and providing optimal patient outcomes.

Join the Fiesta, Enhance Your Expertise!

The Fistula Fiesta session at WOW promises to be an illuminating experience, providing you with valuable insights and skills to tackle the challenges of fistula management with confidence. Whether you're a seasoned healthcare professional or just starting your wound care journey, this session offers something for everyone.

Don't miss out on this enriching opportunity! Click here to learn more about the event and the Fistula Fiesta session.

Fistula Fun at Chicago WOCN Conference

The upcoming Professional Education Day of the Northern Illinois Affiliate of the Wound Ostomy and Continence Nurses Society (NIAWOCN) includes a pair of exciting enteric fistula presentations.  Dr. Erik Borncamp, Medical Director for The Wound Center at Silver Cross Hospital, will present "Ostomy, Fistula and Open Abdomen".  He will discuss the pathophysiology of fistulas and the challenges in closing them.

Mary Anne Obst, Complex Abdomen Specialist for Regions Hospital, will close the conference with her "Fun with Fistulas" presentation.  She will cover assessment and classification of the enteric fistula patient, medical management and wound care principles.

The NIAWOCN's 23rd annual professional education day is October 13, 2021 from 7:00am-4:00pm CST at Bobak's Signature Events and Conference Center in Woodridge, Illinois.

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.

belt 1

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.

Scribe line

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.

belt 3

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.

belt 2

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

belt 4

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.

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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.

container 1

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.

container 2

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.

container 3

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.

container 4

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.

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.

Drop x

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.

Pouch 1

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.

Pouch 2

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.

Pouch 3

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.

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.