Enteroatmospheric fistulas with open abdominal wounds; the challenges of transitioning from a hospital setting to home

Enteroatmospheric fistulas with open abdominal wounds; the challenges of transitioning from a hospital setting to home

            The number of patients admitted with high output enteroatmospheric fistulas has increased at Promise Hospital of Salt Lake a long term acute care hospital (LTAC). Patients and their caregivers face many obstacles when managing this condition. Once it’s established that the fistula will not spontaneously close and/or the patient is not eligible for surgical closure patients are managed with either negative pressure wound therapy (NPWT) isolating the fistula or with a wound manager. The use of NPWT with isolation of the fistula can be effective in an acute care setting with careful monitoring of the fistula, patient immobility, and restricted diet (NPO). Upon transition to lower levels of care these fistula patients are expected to advance their mobility and diet causing these systems to fail. Promise Hospital’s Wound Care Team has developed a containment system that promotes healing of the wound while withstanding an increase in activity and diet.

             This fistula containment system uses a pectin base barrier pouch in conjunction with a hydrophilic white foam wound contact layer. Wound healing and containment of effluent is accomplished with the addition of a gastric suction pump to provide NPWT. This system is proven to be successful in both the acute and home care setting.  Included in this case study are 4 patients with varied demographics and diagnoses.  Each of the 4 patients showed significant improvements in peri-wound skin integrity, granulation tissue, decreased wound size, improved patient comfort, increased mobility, and were able to discharge to home with this system in place.  3 of the patients went on to heal abdominal wounds up to the fistula edge and one had an additional surgery for re-section of the fistula.