Adapting to Complex Clinical Situations: Tackling Ostomy, Fistula and Negative Pressure Wound Therapy Challenges

Problem:

Wound Ostomy Continence Nurses(WOCN) are often faced with a variety of clinical challenges that involve complex stomas, wounds with enterocutaneous fistulae (ECF) and application of negative pressure wound therapy (NPWT) dressings. These clinical situations, if not addressed properly, can cause increased RN workload, peristomal and periwound chemical denudation, as well as patient discomfort and increased costs.

Significance:

WOCN’s have used a myriad of product choices in an attempt to address difficult to manage wound and ostomy patients. Often, seasoned and new practitioners alike may struggle to find a consistent and effective solution to care for these patients.   Hospital stays are shorter and complex patients are being managed in a variety of settings which can make delivery of consistent care more challenging.

Moldable, extended wear barrier rings are traditionally used to prevent leaking in difficult to pouch stomas. Their increased resistance to fluids and enteric effluent make them more durable then barrier paste and prevent peristomal skin breakdown. In the hands of the WOCN, however, this seemingly limited role is supplanted by the adaptability of their performance, allowing for non-traditional applications.

Implementation:

This poster will demonstrate how one product can be utilized by the WOCN in a multitude of case studies demonstrating: application of NPWT to mucocutaneous separation, isolation of ECF in an abdominal wound as a secondary wound dressing, application point to achieve a suction seal for NPWT in a complex perineal wound, filling contour defects in difficult to pouch abdominal ECF, and pouch adherence in peristomal creases.

Conclusions:

Sharing best practices helps to contribute to better patient outcomes across a diverse continuum of care. Patients experienced longer pouch wear times, decreased peristomal and periwound chemical denudation, improved wound healing, increased effectiveness of NPWT systems through decreased risk of seal leaks and provided for patient comfort.