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Discussion

Fistula pouch issues

Currently treating a 9 year old with hepatic embryonal sarcoma and open wound with enterocutaneous fistula that has stomatized in a 3rd of it (RUQ measuring 5cm x 2.5cm following rib line). Now it has stopped draining from the stomatized fistula portion and is draining by the superior skin edge. (Argh!) He is constantly leaking and we have to manage skin breakdown constantly. We use crusting method, several Eakin's rings to protect good skin, medical adhesive spray, and a Eakin wound manager. Any other suggestions or products that have been used that we can try. If we make it 2 days without leaking, we celebrate. Thank you all for any help!!!!

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    I currently have a pt with an enterocutaneous fistula that weighs 98.2lbs..... The fistula is located in the middle of her lower abdomen right above her pubic hair line..... I have had this pt for a week now and so far we have kept the surrounding skin completely intact..... The treatment were are doing is:

    1- Cleanse area with Hibicleanse and pat dry,

    2- Apply NonSting Skin Prep to surrounding intact skin (we are using this GENEROUSLY and make sure you apply the skin prep to all skin that will have the adhesive dressing over it),

    3- Apply Aquacel AG Extra directly to open area (we take 1/2 of a 4x4 and fold it... Then place over open area),

    4- Apply 4x4 NonAdhesive Foam Dressing (lay this over the Aquacel),

    5- Secure with (4) Tegaderm 4x4 Transparent Film Dressings by completely covering the above layers.

    By using the Tegaderm transparent film..... It will keep the dressing intact and prevent leaking. The Aquacel and Foam layers really help keep the drainage confined instead of leaking out onto the pts clothes or sheets (before this current treatment I was changing this dressing 4-6 times in a 12hr shift) If the area is hairy.....SHAVE IT! It will help seal your dressing and put a smile on your face bc you don't have to change it all the time :)

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