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Troughing With Eakin

Author: Jo Hoefl ok RN, BSN, MA, CETN(C), CGN(C), Advanced Practice Nurse, St. Michael’s Hospital, 416-864-5112
 
This case study looks at the use of Eakin Cohesive® Skin Barriers to protect the area around an open midline abdominal wound and fistula.
 
Clinical Issue:
  • Open midline abdominal wound with matured fistula to right lower edge
  • Open right lateral transverse wound with abscess/fistula deep in tissues
Goals of care:
  • Protect the skin
  • Control odor and drainage
  • Ensure patient comfort and mobility
  • Facilitate care for staff.
SuppliesSuppliesSupplies needed:
  • Eakin Cohesive® sheets: 839003
  • Stomahesive® paste: 183910
  • Tegaderm™ on a roll (3M)
  • Scissor set with forceps
  • 2 x 1-piece pouches (ConvaTec): 22771
  • Dry/wet non-sterile gauze
  • Blue pads
  • Garbage bag.

 

Step 2Step 2Step 1Step 1Application:
  • Build trough from the bottom of the wound
  • Cut pieces of Eakin Cohesive® to follow the contours of the wound
  • The Eakin should not be directly at the wound edge, about 0.5 cm away from it.
Step 4Step 4Step 3Step 3
  • Cut pieces of Eakin Cohesive® to fit side contours of the wound
  • There should be overlap with any adjacent pieces (about 2cm of overlap)
  • Build Eakin Cohesive® on both sides
  • Beware of fistula orifice, do not occlude with Eakin Cohesive® or paste.

 

Step 6Step 6Step 5Step 5
  • Begin to build the Eakin Cohesive® for the transverse wound, again overlapping pieces and starting from the inferior edge
  • Continue to build around the lateral edge and upper edge of the transverse wound with Eakin Cohesive®

 

 Step 8Step 8Step 7Step 7

  • Apply a bead of paste to all inner edges of the trough, with a “double” layer at the bottom of the lower midline wound
  • Cover entire trough with long sheets of Tegaderm™
  • Each piece should be overlapping as well.

 

Step 10Step 10Step 9Step 9

  • Cut holes in the Tegaderm™ to allow for the effluent
  • The midline hole should be at the very bottom of the trough, where as the transverse hole should be at the bottom, but more medial
  • Both holes should be slightly smaller than the largest opening of the 1-piece pouches
  • Prepare the pouches
  • Cut the openings to the largest size allowable
  • Take off release liner and put a bead of paste at the inner edge.
 
Step 12Step 12Step 11Step 11
  • Apply pouches over each opening in the Tegaderm™
  • Apply clips to pouches
  • Secure outer edges of each pouch with thin strips of Tegaderm™
  • Patient should lie flat for about 20-30 minutes after application to allow to warm and adhere.