Emergency Fistula Management Kit

Enterocutaneous fistulas (ECF) are abnormal communications between the small or large bowel and the skin.  They are responsible for a significant mortality rate, ranging from 5-20%^1-4, due to associated sepsis, nutritional abnormalities, and electrolyte imbalances.

Understanding the pathophysiology of ECFs, as well as the basics of acute treatment and skin management should help staff to better manage patients during their acute care stay and reduce the occurrence of after hour calls to WOC nurses. Moreover, an established treatment guideline with an individualized care plan and targeted supplies should help clinicians to achieve a better outcome in patients with an ECF with less waste of resources.  Initially floor staff were utilizing as much as 6 hours per shift on one fistula patient.  This was creating significant stress on the staff and loss of MedSurg personnel.  Additionally WOC nurses were expending as much as 20 hours of overtime per week coming into the hospital to repair leaking fistula pouching systems.  

An “emergency fistula repair kit” was designed and presented with education.  Each kit contained an individualized pattern, set of instructions, and basic dressing supply needs to allow a staff nurse to efficiently change or repair a pouching system on their patient. A basic course in the etiology and acute treatment of ECF was established and presented to each shift of nursing staff on floors that managed ECFs.  Additionally, charge nurses and key staff rotated for a day with WOC nurses one on one to receive additional hands on training in general wound and skin management, product selection, patient assessment, as well as fistula techniques.    The introduction of the emergency kit and staff education resulted in increased staff confidence, reduction in overtime hours, and increased patient satisfaction.