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Fistulas remain a challenging situation with the novice and experienced nurse
at the bedside. Enterocutaneous fistula require a multidimensional
approach due to the potential deterioration of the periwound epidermis from caustic
proteolytic enzymes, risk of infection, possible electrolyte imbalance and distortion of
patients psyche. Pouching is a widely accepted dressing method although there are
situations that prevent the application of current specialty fistula pouches. Additionally,
it can be a financial burden if supplies are indiscriminately applied without success.
A situation that precludes the use of a specialty pouch is a midline incision with
retension sutures and a fistula at the superior and inferior portion of the incision.
In addition to the uneven abdominal contours, there were multiple tubes/drains
located within the peri fistula skin area. Troughing the effluent and pouching inferiorly
remains a viable option. This method has a long history but is easily forgotten
due to advanced products. It is streamlined for the general nursing staff to follow,
financially advantageous, provides the criteria for fistula management and enhances
patient satisfaction with dignity.
Partnership with the patient, WOCN and nursing staff is key to success.
Basic ostomy and wound care products can easily be manipulated to achieve
the desired goal. Use of a solid hydrocolloid barrier and paste, transparent
dressing, skin sealant and a one piece, drainable pouch were used and are standard
products maintained in Materials Management. Continuity of care was achieved by
enlisting photography and written instructions. Patient’s progress was assessed weekly
as the fistulas and incision healed.
Collaboration with multiple disciplines positively impact patient safety and outcomes.
Fistula management can be simple or complex but alternatives enhance success.
Troughing is a technique that nursing staff can use when specialty fistula pouches are
not appropriate or useful.