Feacal Management Systems???

cherrybreeze, ADN, RN · Oct 18, 2008

My facility uses flexiseals. I had no idea they were so pricey, though (but I suppose if you weigh in the costs of skin break down from excoriation, or delayed healing of already-present coccyx wounds, it might even out?). The nice thing is that if they fall out, you don't need to put in a whole new system, you can reuse them (obviously on the same patient).

Curious about the Hollister type now, too....will have to look in to that.

mommybear · Oct 18, 2008

i read how a hospital took it away due to cost, we've used zassi for 29 days that is around $10 a day, what is that price compared to nursing time, linens, barrier creams and with the new cms guidelines i don't want to help pressure sores happen due to fecal incontinence............this is a cheap alternative if you ask my opinion, how much is a tube of barrier cream, cleaner, wipes, linen changesm nursing time and exposure to c-diff or others:nurse: our purchasing did a cost analysis and showed how we would save money. the zassi doen't get expelled like fms due to stool thickening,

rn undisclosed name · Oct 18, 2008

I have used the flexiseal system. They do have a website but I have never gone on it. I have never inserted one but did go to an inservice and it seems like it is not too difficult but I never could understand exactly how far to go in. I believe it has to be above the external sphincter muscle but how do you know exactly where that is? Also how do you determine rectal tone? I am not in the habit of sticking my fingers into someones rectum and don't want to start just for practice. I'm sure my patients won't really appreciate it.

mommybear · Oct 18, 2008

this web site will tell you about zassi and has links to other sites for case studies etc

click here for the hollister website

don't bang your head against the wall, go with the inventors of the bowel management system, it works and have lots of advantages

:banghead:

mskate · Oct 18, 2008

i used to prefer flexiseals but now i love zassis more.

say you have a patient in hepatic enceph. severely. they need faster lactulose. - you need to give a lactulose enema. but they are too out of it to retain it - flexiseals can force retention of enemas - AND give you easy clean up!

perfecto!

mommybear · Oct 18, 2008

I think your last sentence should be BMS not flexiseal. I know what you are talking about, it is a superior system, I like the fact that I can get a stool sample through the port, I also like the drainable bag it's 3000cc, they have a disposable for C-diff patients that holds 2000c....................... the material is a lot nicer too, easy to milk the stool down, I find this stays in longer because of the way you maintain the product, I had problems with the others getting expelled and leaking lots...........more than a chuk full:redbeathe

mskate · Oct 18, 2008

I think your last sentence should be BMS not flexiseal.

flexiseal is a brand. so is zassi. both of them are BMS, both very different.

mommybear · Oct 18, 2008

I understand what you are saying except Zassi was the first to call it BMS and it's on their literature, the Flexiseal by Convatec is FMS fecal management system.

I agree, both are very different that's why we use the Zassi..................sorry for the misunderstanding.

At least we both agree that the Zassi is better.

hillsideRN · Mar 9, 2009

You may want to look into the new DigniCare system from Bard. Our unit recently switched over from Zassi (initially used Flexiseal, but it was a very poor product). Huge difference in odor control as they have a closed system when you do a bag change. also the distal end is a low-pressure cuff, it stays in better without leaks, has a catheter irrigation system to help fecal matter flow, and was much less expensive.

mommybear · Mar 10, 2009

I found the Zassi bowel management system the best, it doesn't need an irrigation system to move stool, it doesn't leak, has a sample port for stool, has a drainable or closed bag system, and the use of Vanco through the only one approved By FDA for med administration is great. Vanco is absorbed in the colon not the gut. The others are only copy cats, Zassi was first and engineered and invented by colorectal surgeons. They have all the evidence based studies to support the product, Bard has none............

mommybear · Mar 10, 2009

There is a definite difference in these systems. You need to understand the bowel management vs liquid stool. The bard and flexiseal need to be removed when stool gets thicker, does that mean it's ok to have thick stool in the wound? I don't think so. With the Zassi you have a true bowel management system and it has all the bells and whistles that the others can't even come close to matching. Why not settle for the top, the first the one show spent all the engineering dollars and the market research, white papers, clinical etc. Zassi is who I would choose for material, quality and the training done by nurses.

specialk12700 · Apr 1, 2010

my essay on flexisils how fun

A common and useful intervention for patient's that are continuously incontinent is the use of a Flexisil fecal tube bag. When a patient is consistently incontinent of diarrhea, he/she is at risk for a variety of issues that may arise. The skin's integrity is at risk for breakdown when diarrhea leaves the skin excoriated and always damp. The skin will erode and break down if the stool is not properly cleaned up. Most nurses turn and reposition patients every two hours, and this amount of time for the patient to be lying in stool is not an option. Thus, the Flexisil Fecal tube was invented to reduce the risk of skin breakdown by effective fecal diversion and containment. It also prevents wounds, surgical sites, and burns from the effects of fecal contamination, which can lead to infection. It minimizes the chance of tissue breakdown and muscle atrophy by way of a soft balloon design. It also assists the nurse in not having to clean up the patient as much, as it is contained in the tube. This is beneficial to the patient, as well as the medical staff assisting with the patient's care. The tube is collected in plastic bag the same way a Foley catheter bag works. It's all a contained system, so if a sample is needed to be collected you can remove it from the bag. It is intended to make a convenient and contained method of collecting the loose stool. As a nurse on a medical surgical floor, I have been working with a Flexisil and having issues with them for the past five days. These issues will be discussed and methods involved in attempting to solve them. Over the past few nights, I have had two patients on the front hall who were dealing with fecal incontinence and the use of Flexisil fecal tubes to collect the loose runny stool. The patient in 604, E.R., had a stage four decubiti as well as C. dificile infection, causing her to have consistently orange loose runny stools. She had a Flexisil, in which 45 milliliters of free water is supposed to be instilled into the tube once inserted into the rectum. For five days I would change her on an hourly basis secondary to the Flexisil tube leaking around the site. She would put on her call light, saying she messed the bed. The assistants were fed up with cleaning her every hour and refused to go in there, stating she/he was entirely too busy obtaining post op and blood vitals, which is understandable. Sure enough I had cleaned her up almost hourly, changing her dressing that kept soiling. People have put new tubes in her rectum; have instilled more water inside the balloon, and the various other interventions, none with any results diminishing the leaking tube. This was causing a problem to the busy nursing staff, as well as creating an even more stressful environment on 6 Main. In another scenario right down the hall, W.M. had a C.diff infection as well, but her case was more challenging. Her fecal tube would not stay in, in my opinion due to anal sphincter atrophy. Her tube was reinserted several times on one eight hour shift alone, would stay in for several hours and then pop back out. Her bed would be fully saturated with loose stool, and she would not tell us, creating a situation that set her up for sepsis and skin integrity breakdown. Thus I would go in the room to check on her, knowing that her bed was potentially saturated with stool. Ways found to attempt to fix these methods would be to instill air into the balloon instead of water. The 45 milliliters of water allowed the balloon to be deflatable and movable inside the rectal canal. The air instilled created a more firm wedge inside the patient's rectum, allowing it to not be tampered with. Also, by relieving pressure from the exit site by turning the patient on his/her side, the chance that the tube would pop out was minimized. The answer to instill more water into the balloon would not be the answer, as it could create tissue atrophy and would pop out nonetheless. Patient's with rectal or colon cancer could not benefit from a Flexisil either, so the intent to review the patient's past medical history is a must before inserting any catheter. The Flexisil tube, as stated by many nursing forums online, will always tend to leak a little around the site. This is the answer for 604's case, and as bothersome as she seemed to use, the necessity to scrub her spotless every time needed to be instituted. The answer to how to keep W.M.'s tube in is a mystery, as when I instilled air into the tube, it would still pop out in two to three hours. There is no answer to the leaking Flexisil tube right now in nursing practice, and no one has really found the right answer. At 900 dollars a box once opened, each Flexisil tube is quite expensive and some hospitals do not even use them. If these patients did not have the tubes inserted at all, there would be countless amounts of issues they would have to resolve, including skin breakdown and sepsis. Flexisil fecal bags need to become more appreciated in the nursing practice, and hopefully one day someone will invent one that stays put without complications. In the meantime, I will continue to use these with patient care.