Fistula Care - Fistula Solution

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.

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.

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.

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.