A 9 year old girl sustained multiple injuries while a restrained passenger in a motor vehicle accident in which her mother and identical twin sister perished. Initial diagnoses included abdominal aortic dissection at the renal artery, multiple intestinal perforations, sub arachnoid hemorrhage, pulmonary and myocardial contusions, and other injuries. During the first 6 weeks of hospitalization, she had 23 visits to the operating room for wash outs, bowel decompressions, resections of necrotic bowel, and intestinal repairs. Ultimately the abdominal wound was treated with split thickness skin graft around multiple fistulae. Problem: After close to a year of hospitalization, she was ready for discharge in every aspect save for the need for continuous suction to maintain the integrity of the fistula pouch. Portable suction machine was effective, but much too loud to live with on a constant basis. Clinical Approach: The hospital purchased a negative pressure wound therapy machine to send home with her. The diameter of the machine’s canister tubing was too small to accommodate the fistula effluent, thereby compromising the function of the suction. The WOC team attached a standard suction canister to the machine’s canister so that the effluent was collected into the standard suction canister. This system provided silent continuous suction. Outcome: The patient was discharged to home with her fistula pouch intact and connected to suction. She came to us daily for pouch changes, but she was able attend public school, resuming a more normal routine. She adapted to carrying the machine and canister with her. Conclusions: Partnering with the discharge team of the children’s hospital and the vendor, the WOC team helped achieve a sustainable discharge plan. Her fistula has since been closed, and she remains on total parenteral nutrition until her intestinal tract is surgically put back into continuity
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