STATEMENT OF CLINICAL PROBLEM: The management of fecal incontinence in an acutely ill, morbidly obese patient is a major nursing challenge. One such patient was a forty nine year old, morbidly obese male admitted through emergency room with poorly controlled, insulin dependent diabetes, end stage renal, self-administered peritoneal dialysis, and multiple co-morbidities.

While having copious drainage from abdominal wound, he experienced perpetual liquid to semi-formed feces with a volume of 1000 cc in an eight hour shift. The patient experienced skin excoriation and rapid skin breakdown in the sacral area. Due to his size, he required a special bed and padding to protect that bed. It required two nurses an average of 15 minutes every two hours to clean up each incontinence episode.

PRIOR MANAGEMENT: The patient was in the intensive care unit 3 ½ months, on and off the ventilator. Rectal tubes and foley catheters were tried unsuccessfully. Regardless of skin barriers being used, skin breakdown occurred. His stool grew C-diff.

CURRENT MANAGEMENT: The fecal management system was selected as it may remain in place up to 29 days. After the insertion of the system the patient had no leakage and the stool was easily collected. The collection bag was changed without spills or leakage. Nursing time was decreased in half from 6 hours to 3 in a 24 hour period. The patient benefited from improved skin condition and uninterrupted sleep as he did not need to be cleaned up from incontinence episodes.

CONCLUSION: The fecal management system improved patient care; aided in improving skin integrity; reduced potential exposure of healthcare workers to stool; and decreased odor. This product has been placed in inventory and improved patient care on each successive use.

*Flexi-Seal" Fecal Management System

Flexi-Seal is a registered trademark of E.R. Squibb and Sons, L.L.C.