Sacral fistula

[Mcgarrity01]

I have a patient who has a sacral fistula s/p radiation. He is not a surgical candidate and has copious drainage which requires bid dressing changes. He is constantly wet. We are currently using 1/4 inch packing strips and mepilex sacrum dressings. I need to know if there is something better for this patient. I have been searching on line for months now with no help. Several articles which suggest surgery, but he is not a candidate. Tried using an ostomy bag which popped off after just a few minutes. Please help

[traumaRUs, MSN, APRN]

Oh this poor man - how painful and embarrassing. Thank you so much for caring enough to research this.

Welcome to AN the largest peer to peer nursing network. While I don't have any specific answers, I'm sure that you will get some answers here.

[icuRNmaggie, BSN, RN]

I worked in a third world hospital and the surgeon placed a 32 Fr foley to an abdominal fistula, sutured it and placed it to LIWS. It drained 2 Liters a day at least.

Is it possible to utilize a wound vac or just the vac dressing and attach it to straight drainage ?

[icuRNmaggie, BSN, RN]

I just remembered tnat it wasn't a foley at all. It was a Malecott tube. Sorry.

[Mcgarrity01]

Hi..thank you for your reply. He has had a wound vac. Unfortunately, it will never heal. How could a male cot tube be used? I am so interested in this idea....not sure how exactly it would stay in place d/t the area. Also, with the vac dressing, how would you attach a drain? Any explanation would help me to help him. All docs are at a loss and this poor man is constantly draining.

[icuRNmaggie, BSN, RN]

If I remember correctly the abdominal wound was about the size of a quarter and the malecott tube was placed at the bedside and sutured in by the physician. It worked very well to relieve the abdominal pressure of from the constant thick drainage. 2 to 3 liters a day. The tube could also be placed to straight drainage like a foley.

The poor man also had Hansens disease or leprosy and we could not get him to the U.S. so it was a palliative measure.

I have never seen a sacral fistula but I thought it was worth mentioning. I guess it depends on the size of the wound. Malecott tubes do come in different sizes.

Would the benefit of containing the drainage outweigh the discomfort of a tube in between the buttocks, I don't know. Maybe if he is bedbound.

I was thinking that the wound vac circular dressing and a canister alone might work, just to catch the drainage but that is probably an illegal off label use and a poor idea.

[Mcgarrity01]

I have been thinking about a catheter. It is worth a shot. I am going to ask the doc tomorrow at work. I lose sleep over this man as Medicare guidelines are so strict on the amount of supplies he is allowed per month. He is young and must live with the constant drainage. The fistula formed from radiation d/t rectal cancer. If he had a collection bag, his life would be so much easier. ThAnk you for replying.

[Davidaugustyn]

Fistulas are the hardest things to deal with. I shutter when I hear of a new admit coming with a fistula...I wish I could give you better advice...Supplies are drained to quickly with them...