Management of A complex peristomal calciphylaxis

Introduction: Calciphylaxis/Calcific Ueraemic arteriolopathy a rare poorly understood syndrome of small blood vessels becoming blocked leading to black painful necrotic areas of skin. Mortality rate is 60-80%. Patients affected have long standing history of chronic renal failure with other pertinent risk factors. Calciphylaxis lesion requires extensive & intensive wound management with medical interventions for patient to survive sequelae of sepsis.

Case: Middle age male with extensive stage 4 pressure ulcer to his sacrococcygeal area requiring diverting colostomy to heal the wound. Diagnosis of chronic kidney disease with hemodialysis since 2007, diabetes mellitus & incomplete paraplegia is noted. Initial plan is to have diverting colostomy for eventual skin graft of his sacrococcygeal wound. Hospital stay was complicated by the development of peristomal calciphylaxis lesion(PCL) which made pouching challenges for staff. This required multiple pouching changes to keep peristoma  clean. High acuity care needs of patient was aggravated by patient's non compliance to diet restriction, pressure ulcer prevention efforts of staff & continued need for high doses of pain medication presented a challenge for health care team & safe discharge planning.

Discussion: Wound/Ostomy team tried & evaluated various wound care products & different pouching techniques to increase wear time & help heal the PCL. Products like hydrogel, Hydrofiber Ag, gentian methyline violet & enzymatic collagenase ointment were used based on the progress of the PCL. Staff education & Interdisciplinary team effort in managing patient's medical and surgical issues assisted in dealing with patient's case.

Conclusion: PCL decrease in surface area affected & improved in appearance with  use of  various advance wound care product as patient's medical condition improved. Utilization of nursing process, intensive interdisciplinary collaboration have significantly manage complex PCL.