Use of Fistula Pouch to Manage Clinically Challenging Drainage Containment Situations

Statement of Clinical Problem: Certain clinical situations pose drainage containment challenges because of their size or close proximity to other problematic conditions. Three such problems were encountered within a three-month period warranting the use of nontraditional pouching systems. These included: a long draining midline abdominal incision extending distally beyond a deep suprapubic fold, a fistula within an open wound, and a large colostomy stoma close to a copiously exudating midline incision. Description of Past Management: Without access to large containment devices, either multiple small pouching systems placed next to or on top of each other, or management with frequent dressing changes were the only treatment options for such conditions. Both required frequent changing by the nurse and/or WOCN. Current Clinical Approach: The availability of large flexible fistula pouches of varying sizes and shapes has allowed for successful pouching of not only complex fistulae, but also of other large draining wounds or large stomas. Fistula pouches were used successfully in the fore-mentioned cases. Patient Outcomes: The durability and conformability of the fistula pouch provided 4-7-day seals over the copiously exudating midline incision with uneven abdominal topography and over the fistula within a large open wound. As for the large colostomy stoma near a copiously draining incision, the fistula pouch could be trimmed (unlike a wider 4-inch 2-piece appliance), clearing the incision so that the incision and stoma could be treated independently of one another. Conclusions: Having immediate access to fistula pouches became a necessity in our facility as patients with urgent complex pouching problems cannot wait for non-stocked products to be special-ordered. Fistula pouches improve patients' quality of life during challenging times, as well as decrease nursing time/cost spent on frequent dressing changes. *EakinŽ Fistula Pouches Eakin is a registered trademark of T.G. Eakin Limited