Fistula Management Across the Continuum of Care

Problem Statement: In a large tertiary-care setting, complex fistulas in patients ranging in age from neonates to elderly adults present on-going challenges for healthcare providers and patients. Many of these fistulas are present in large abdominal wounds and a system to promote wound healing was needed. Containment of effluent and protection of perifistular skin is also essential in management of these fistulas. Without this containment and protection, quality of life, physical activity, pain management, supply costs, and caregiver time may be negatively affected. A need for an effective management technique was identified.

Past Management:  Patients in these case studies were managed with negative pressure wound therapy (NPWT), gauze dressings, and fistula pouches to straight drainage.  The NPWT system was ineffective due to the high volume of output and resulting skin breakdown. Gauze dressings required very frequent changes and skin breakdown occurred rapidly. The fistula system to straight drainage did not maintain an effective seal.

Clinical Approach: A soft flexible wound pouch that is available in a variety of sizes and into which a catheter could be inserted and connected to suction proved to be effective. Three case studies described here demonstrate the variety of situations in which this system has promoted wound healing around the fistulas, decreased pain and improved quality of life for patients.

Outcomes:  Patients were able to be discharged from the hospital with an acceptable degree of mobility, and care that could be managed when transferred to other hospitals, skilled nursing facilities or home health care.

Conclusions:  The use of a pouching system connected to suction which provides negative pressure and straight drainage when patient has been allowed to be out of bed is effective across age groups and care settings.

Eakin^Ò Fistula and Wound pouches

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