"Let's Try a Baby Nipple": Creative Management of a Complex Abdominal Wound

As a WOC nurse, it is important to think outside of the box while problem solving for complex situations, and to adapt quickly to a situation while maintaining the safety of the patient.  Getting creative with non-ostomy or wound related products can surprisingly make the difference in a situation. 

A 48 y/o critically ill female patient with Crohn’s disease was admitted to our large, 1000+ bed urban hospital on 08/03/11 for more intense management of her disease.  The patient had undergone multiple abdominal surgeries prior to her admission, and subsequently underwent two further abdominal surgeries for resection of ischemic and necrotic bowel leaving her with <70cm of small bowel. The patient was left with short gut syndrome and a high output ileostomy.  The patient’s post-operative course was complicated by abdominal wound dehiscence with undermining extending bilaterally toward the lateral aspects of the abdomen, and complete ileostomy mucocutaneous separation.   

Through close collaboration with the patient’s surgeon, negative pressure wound therapy was applied to the abdominal wound.  However, due to the mucocutaneous separation and undermining into the abdominal wound, the ileostomy effluent was drawn through the mucocutaneous separation and into the abdominal wound.  The abdominal wound was essentially bathed in ileostomy effluent.  In an effort to prevent this from happening, a creative approach was taken.  A baby nipple with the tip of the nipple cut off was taken and placed around the ileostomy. The base of the ileostomy was wrapped with a nonadherent mesh gauze.  The ileostomy site was pouched with a convex pouching system and connected to LWS via a fenestrated catheter placed into the pouch.  Negative pressure wound therapy was re-applied to the abdominal wound, and a seal was achieved. Creative thinking and unconventional use of a baby nipple led to completed wound healing in this complex and challenging patient.