Case Study of Difficult Entercutaneous Fistula

Statement of clinical problem:

A 30 yo male, no co-morbidities, s/p golf cart crash in august of 2010 that occurred in another state which resulted in blunt abdominal trauma.  After multiple procedures that resulted in 3 enterocutaneous fistulas in a STSG mid-abdominal wound, he was transferred to his local hospital. 

Description of past management:

The out of state facility had no WOCN and the dressing constantly had leaking issues with skin maceration and breakdown.  The dressing he came with was hydrocolloid with barrier rings and (2)  2 ¼” flat wafer and drainable pouches.  Frequent, painful dressing changes that immediately leaked became the norm. 

Current Clinical Approach:

The patient was discharged home 3 months prior to the expected discharge time set upon transfer.  Several different dressings were attempted with random successes and failures.  Once discharged, he followed up in our Outpatient Ostomy Clinic where combinations of different fistula management systems, hydrocolliods, barrier rings, wafers and pouches along with specifically placed bolster devices and a  binder were used together to create a dressing that allowed this patient to go from multiple weekly dressing changes to weekly dressing changes and independence to have the quality of life he desired.

Patient Outcomes:

The patient’s subjective response was better dressing changes, with less pain, and better quality of life.   The patient was able celebrate momentous occasions in the lives of family and friends.  The objective data was developing a pouching system specific to this patients needs therefore providing him with a better quality of life. The patient verbalized the difference in care he received between the two facilities and he valued the specialty of the WOC nurse.

Conclusions:

The knowledge obtained through the WOCN curriculum establishes a foundation to creatively solve challenging patient situations