Abdominal Fistula Management: Three Different Aproaches

Abdominal Fistula Management: Three Different Approaches

Clinical Problem:

            Fistulas can develop spontaneously without prior surgical intervention or after surgical intervention as a result of poor healing, previous radiation, multiple prior surgeries. Various management methods are available: gauze, pouches and Negative Pressure Wound Therapy.  Fistulas are challenging for patients, families and WOC nurses.

Patient Outcomes:

Gauze can be an appropriate option if drainage is minimal, less than 400cc/day and doesn’t compromise patient ability to care for self. Pouches are made in a variety of sizes by a variety of manufacturers with various attachments to drain and contain output. Negative pressure has been used to heal fistulas although there is some concern that it might enhance their development. Depending on volume and contours of the abdomen each option can be appropriate. Maintaining a management method in an acute setting needs to be replicated if possible in another level of care like extended care facility or home. Optimizing containment, healing potential, mobility, and cost are factors to consider.

Conclusions:

            A review of how these options work enables WOC nurses to feel confident in their fistula management.