Enteric Fistula Management: Dressing Selection Decision Process to Improve Fistula Patient Outcomes

Clinical Problem

Enteric fistula dressing management is a significant clinical challenge. We reviewed the patient gallery of our Complex Abdominal Reconstruction team for the consequences of inadequate fistula care due to dressing failure. Identified issues include malnutrition, pain, emotional and physical health, deconditioning and prolonged hospitalization¹.

Past Management

Enteric fistula dressing failure includes inadequate wear time, leaking, and periwound skin break down. In the past, clinicians creatively used gauze and skin protection, pouching, and negative pressure dressings to isolate fistula effluent with mixed results². This abstract will describe a structured dressing selection based on fistula stage and type with innovations to application that increase dressing success.

Clinical Approach

Our approach to enteric fistula management starts with identifying the fistula stage and type and tailoring the dressing to the fistula. As a fistula develops, management changes and so does the dressing care plan³. A dressing decision tree diagram will be presented for clear instruction around this process.

Each of the identified issues compounds the next; however dressing successes can break this negative cycle. Successful dressings allow for enteric nutrition to be provided, which is optimal for intestinal health and preparation for surgery. Pain can be controlled with less narcotic use. Mobility and conditioning become a reality and in our practice inpatient facility use is decreased.

Patient Outcomes

Fistula management needs a team process to provide the best quality of life for the patient. We focus on dressing management techniques and when and how to employ each. The dressing selection for the three patient profiles, allowed for enteric feeding, improved conditioning and home stays prior to surgical revision.

Conclusion

Our clinical approach and dressing decision tree are tools that we hope will help other clinical teams provide improved outcomes and the best possible quality of life for fistula patients.