Purpose: To present a case study involving the isolation of a fistula from an abdomen wound using multiple treatments, in the home care setting.  Also working with the family dynamics revolving around the husband’s anger and the patient’s difficulty coping with body image change.

Patient History: dx-ovarian cancer. 9/5/07 patient was admitted for total abdominal hysterectomy, large bowel resection, spleenectomy, appendectomy, liver resection, right diaphragm reconstruction.  Hospitalization complicated by abdominal abscess, fistula and several surgical repairs. Disconnect between the hospital and home care regarding the patient’s treatment.

Clinical Approach: The poster will demonstrate a review of the patient’s wound and fistula during the course of 4 months.  It will review the different pouching and wound care techniques used as the wound progressed.  It will also demonstrate how the use of case conferencing with a team approach assisted in caring for the patient and managing the wound.  The team was made up of nurses, clinical manager, WOCN’s, doctors, social worker, and the patient’s family.

Outcomes: We needed to change our approach as the wound healed and fistula changed.  This resulted in different pouching and wound care treatments almost weekly.  As a team we would have discussions on different ways to try to prevent leakage from the fistula for more than 24 hours.  The patient’s husband was taught the wound care, so if/when a leak would happen he would do the wound care on the days the nurse did not visit.

Conclusion: Wounds with fistulas will decreased in size and can heal if you use a team approach, brainstorm, think out of the box, and keep on trying different techniques.  Never give up keep on trying, and you will eventually see success.