Challenging enterocutaneous fistula and tube site management for the wound, ostomy and continence nurse

Introduction-  Effective management of fistulas and tube sites depends on numerous factors.  Dressings, pouching, absorbent materials, and barriers are among the choices for site care.

Case Reports-  An elderly male patient post surgery for colon cancer developed an enterocutaneous fistula in the small bowel.  Abdominal skin folds and scars from previous surgeries made the skin surface irregular. Gauze dressings required frequent changes and left the skin denuded and painful. The pouching surface was leveled by using layers of barrier material and pouch wear time of three days was achieved.

A middle aged female patient post-Whipple procedure for bile duct carcinoma had a gastrostomy and jejunostomy tubes. Copious drainage around the tubes caused denuded and painful skin. Further complications were skin folds and an irregular surface on the abdomen. Baby nipples were incorporated into the pouching system for tube stabilization. This method provided seven-day wear time with skin healing and protection.

An elderly lady post small bowel obstruction due to an incarcerated hernia had a high output fistula located in her small bowel. The exact location of the fistula was not visible and bilious effluent poured into the open abdominal wound. A negative pressure fistula management system with antimicrobial gauze and a drainage tube closed the fistula successfully.

Discussion-  Creative use of products resulted in skin protection, drainage containment, and improved patient mobility. The negative pressure therapy benefits included promotion of granulation and wound closure while diverting fistula output out of the wound bed. This management allowed for earlier transition out of the acute care setting into rehabilitation.

Conclusions-  Many tools are needed in the WOC nurses arsenal to combat the challenges of fistula and drainage tube sites; one size does not fit all. Creativity by the WOC nurse can lead to successful management, patient comfort and optimal wound healing.