Patient Centered Goals, Collaboration, and Persistence Lead to Positive Outcomes in Fistula Patient

CLINICAL PROBLEM: Patients living with Enterocutaneous fistula (ECF) experience lower quality of life and with feelings of loss, depression, anxiety, and discomfort (Hoeflock, 2015). A 79-year-old male ECF patient in small community hospital, with a history of resolved ECF and existing ileostomy was admitted for a small bowel obstruction and had exploratory laparotomy bowel resection. ECF eight days post-op abdominal surgical site with two small dehisced sites one with ECF close to ileostomy. PAST MANAGEMENT: Collaboration with surgeon, Wound, Ostomy, Continence (WOC) nurses, and patient throughout process. Wound care attempted until effluent increased then pouching techniques with various combinations of ostomy pouches, pediatric pouches, NPWT, fecal containment pouches, and fistula/wound management pouches. Wear times ranged from 12-24 hours. CLINICAL DILEMMA: Patient centered goals for self-management and 48-hour wear that would allow him visits with wife in memory care. Many readmissions occurred for various reason. Pouching remained difficult at less than 24 hours for skilled nursing, home health, and patient. Seen in wound clinic and inpatient by WOC nurse for four months and could see patient’s emotional and physical condition deteriorate. CURRENT MANAGEMENT: New product became available a one-piece high output pouch that was flexible with large barrier to pouch upper fistula and ileostomy together. OUTCOME: Patient came in following week for follow up and was getting 3 to 4 days wear. Patient had much higher energy level and shared he was now able to visit his wife daily. Since pouching system success patient has not been admitted to hospital. CONCLUSION: ECF, unlike ostomy placement, are rarely convenient in placement and lead to difficult management (Hoeflock, 2015) even when small. Persistence with attempting different techniques and products, collaborating with surgeon and other WOC nurses, and patient centered goals can lead to improved quality of life and patient outcomes.