Improved Clinical Outcomes with Use of a Large One–Piece Flexible Pouching System

Clinical Problem: 

Unique challenges for our outpatients include fistulas, flush stomas and uneven pouching surfaces.   They usually arrive frustrated, with inconsistent, unpredictable wear times and irritated skin.  Several cases are presented.

Past Management: 

A 50-year-old female, with an obese abdomen presented with four fistulas, including two in a skin fold.  Use of a wound manager with two barrier rings achieved a two day wear time.  A 32-year-old female developed a gastrocutaneous fistula after removal of a g-tube. Despite trying various pouching options, her longest wear time was 20 hours, with recurring peri-fistular skin irritation.  An 80-year-old male with a large irregular, peristomal hernia and flush stoma achieved an average one day wear time with a one-piece pouching system with barrier rings.

Clinical Approach:

Denuded skin was crusted with stoma powder and protective skin barrier wipes.  Thin barrier rings were placed around the fistula or stoma.  A large one-piece flexible pouch was applied.

Patient Outcomes:

All patients achieved significant increased wear time, comfort and improved skin condition.   The patient with the colocutaneous fistulas achieved a four day wear time.  The patient with the gastrocutaneous fistula had improvement in peristomal skin and output containment for six days, enabling travel on a family vacation.  The patient with the large peristomal hernia was able to achieve a four day wear time significantly improving his quality of life.

Conclusions:

Improved outcomes were achieved in various ostomy and wound containment situations with the large one-piece pouching system.  The combination of a large adhesive area and a flexible yet durable barrier enabled more secure seals where abdominal folds and contours typically undermine good outcomes.  Each of these patients reported increased comfort and satisfaction with their care. The reduction in barrier changes helped to decrease our facility’s cost of patient management while helping to significantly improve the patients’ quality of life.