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Management of a Complex Abdomen on a
Patient With Metastatic Colon Cancer
Patty Cimino RN, CWOCN
Wausau Hospital: Wausau, Wisconsin
Statement of Clinical Problem: Care of a cancer patient with multiple enterocutaneous fistulas is challenging in many ways. Basic needs of fecal containment, odor control and physical comfort are all common patient concerns. However, those individuals who have abdominal wall metastasis erupting on the skin surface suffer an even greater level of physical and emotional distress.
Description of Past Management: Product knowledge and creativity of the Certified Wound, Ostomy and Continence Nurse (CWOCN) has proven crucial in clinical situations such as these. In this case study, the patient presented with fungating tumors coupled with two enterocutaneous fistulas within a previously skin grafted site on his abdominal wall. The use of standard ostomy pouch systems was not successful in protecting fragile skin and managing effluent from the fistulas.
Current Clinical Approach: To meet this patient’s needs, the CWOCN researched specialty pouch* options and employed their use. Accessory products that were available to this facility were added to prolong pouch wear time: a washable skin sealant**, stoma paste***, cohesive seals*, ostomy cement**** and waterproof tape*****.
Patient Outcomes: The CWOCN was able to assist the patient and family in meeting the goal of returning home. The family continued pouch changes on a bi-weekly basis for 5 weeks. The patient was able to resume social activities, such as going to a picnic with family and friends, while the integrity of the pouching system remained intact.
Conclusion: It is the perception of the family that it was the support of the CWOCNs and the use of the specialty fistula pouches that allowed the patient to return home and have quality time with his family prior to his death.
*Eakin® Fistula Pouches and Eakin Cohesive Seals. Eakin and Eakin Cohesive are registered trademarks of T.G. Eakin Limited.
**Cavilon No Sting Barrier Film. Cavilon is a registered trademark of 3M Company.
***Adapt Paste. Adapt is a registered trademark of Hollister Inc.
****Torbot Liquid Bonding Cement. Torbot is a trademark of Torbot.
***** Hy-Tapeâ. Hy-Tape is a registered trademark of Hy-Tape International, Inc.
Patient With Metastatic Colon Cancer
Patty Cimino RN, CWOCN
Wausau Hospital: Wausau, Wisconsin
Statement of Clinical Problem: Care of a cancer patient with multiple enterocutaneous fistulas is challenging in many ways. Basic needs of fecal containment, odor control and physical comfort are all common patient concerns. However, those individuals who have abdominal wall metastasis erupting on the skin surface suffer an even greater level of physical and emotional distress.
Description of Past Management: Product knowledge and creativity of the Certified Wound, Ostomy and Continence Nurse (CWOCN) has proven crucial in clinical situations such as these. In this case study, the patient presented with fungating tumors coupled with two enterocutaneous fistulas within a previously skin grafted site on his abdominal wall. The use of standard ostomy pouch systems was not successful in protecting fragile skin and managing effluent from the fistulas.
Current Clinical Approach: To meet this patient’s needs, the CWOCN researched specialty pouch* options and employed their use. Accessory products that were available to this facility were added to prolong pouch wear time: a washable skin sealant**, stoma paste***, cohesive seals*, ostomy cement**** and waterproof tape*****.
Patient Outcomes: The CWOCN was able to assist the patient and family in meeting the goal of returning home. The family continued pouch changes on a bi-weekly basis for 5 weeks. The patient was able to resume social activities, such as going to a picnic with family and friends, while the integrity of the pouching system remained intact.
Conclusion: It is the perception of the family that it was the support of the CWOCNs and the use of the specialty fistula pouches that allowed the patient to return home and have quality time with his family prior to his death.
*Eakin® Fistula Pouches and Eakin Cohesive Seals. Eakin and Eakin Cohesive are registered trademarks of T.G. Eakin Limited.
**Cavilon No Sting Barrier Film. Cavilon is a registered trademark of 3M Company.
***Adapt Paste. Adapt is a registered trademark of Hollister Inc.
****Torbot Liquid Bonding Cement. Torbot is a trademark of Torbot.
***** Hy-Tapeâ. Hy-Tape is a registered trademark of Hy-Tape International, Inc.