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Eakin Fistula & Wound Pouches

This case study uses Eakin Cohesive® Skin Barriers along with Eakin Fistula & Wound Pouches to treat a patient who had developed a wound infection and two abdominal fistulae.

Author: Marg James RN/BN/ET, Horizon Health Network
 
Patient Medical History:

  • 1978: Crohn’s disease
  • 1996: Gastrojejunostomy
  • 2000: Right Hemicolectomy & Ileostomy
  • 2008: Abdominal Perineal Resection & Proctocolectomy
  • 2009 Feb-April: Radiation & Chemotherapy
  • 2009 Dec: Gastroenterologist- Gastroscopy
  • 2010 Jan: Gastroscopy
  • 2010: PET Scan
  • 2010 Mar: Revision of Gastrojejunostomy, Laparotomy, Cholangiogram, insertion Tran hepatic bile drain & pancreatic duct drain
  • 2010: POD 6 - Wound infection? Fistulae
  • 2010 May: Cystoscope to check lining of bladder (blood clots)
  • 2010 Oct 27: D/C home with Extra Mural for abdominal dressing (Eakin Fistula & Wound Pouch)
  • 2010 Dec 12: Hospital admission
  • 2010 Dec 17: Sinogram (fistulogram).

Mrs. J is a 48 yr old lady who was diagnosed with Crohn’s at the young age of 20. For several years she was able to manage her Crohn’s quite well. In 1996 she was having problems with food blockages and had a gastrojejunostomy. In 2000, she began having problems related to her Crohn’s and it was decided that a right hemicolectomy & ileostomy was needed.

In September 2008 a colonoscopy was done. The following December she had an abdominal perineal resection & protocolectomy, for rectal cancer after which she received both radiation and chemo for 3 months. By February 2009 she began to have Crohn’s related issues and was experiencing vomiting and blockages. In December 2009 she saw a gastroenterologist who attempted to do a gastroscopy after Mrs. J had been fasting for 12 hours. At this attempt they were unable to scope her. The second attempt was made in January 2010, after 48 hrs of fasting they were able to scope a little farther.

In February 2010 Mrs. J had a PET scan to assess the extent of her cancer. In March 2010, she was admitted for a revision of her gastrojejunostomy and the above procedures. Following surgery, she was in the Intensive Care Unit for several days, POD 6 she developed a wound infection and 2 abdominal fistulae. From March - October, Enterostomal Nurses worked to find the right product to contain the drainage.

 

Assessments:

  • March 16th 2010: Initial assessment found 2 open areas (incision), top measuring 2.5 cm x 1.5 cm. Bottom open area was 2 cm x 5 cm undermining @ 10 o’clock 2 cm
  • April 12th 2010: Distal incision opened, now 3 open areas
  • April 22nd 2010: Skin breakdown around open area, red, raw
  • April 29th 2010: Trial Coloplast manager
  • May 7th 2010: 2 open areas, 3rd tracked 9 cm @ 9 o’clock
  • June 8th 2010: Trial Eakin Fistula & Wound Pouch
October 2010
  • June 21st 2010: Trial troughing wound with Eakin Cohesive®
  • June 23rd - August 2010: Alternated with troughing & Fistula/Wound Pouch
  • September - October 27th 2010: Patient was discharged home using Eakin Fistula & Wound Pouches
  • October - December 2010: Wound Pouches were changed 2-3 times a week by Extra Mural Hospital staff who called at her home and used the following management system.
 

Management:

  • 3M barrier wipe was applied to peri-wound skin
  • Eakin Cohesive® Skin Barrier applied to indentations at 3 & 9 o’clock. Double layer of Eakin applied to deeper indentation @ 9 o’clock & small amount of Stomahesive® paste applied over strip. A larger strip of Eakin Cohesive® was then applied horizontally from approx. 3-11 o’clock
  • A small amount of Stomahesive® powder was applied to reddened skin around open wound Eakin Fistula & Wound Pouch cut to fi t wound with fistulae. Stomahesive® paste applied to back of manager before applying
  • Appliance cut to fit ileostomy with small piece of Eakin on back of wafer from 1-4 o’clock to assist with adherence to Wound Pouch
  • Silver nitrate stick applied to hypergranulated tissue at tube insertion sites followed by AQUACEL® Dressing & Mepilex® border dressings.
 
15th December 2010

Further Assessments:

  • December 5th - 12th: Fistula & Wound Pouch changed daily by Extra Mural Hospital staff.
    Patient was unable to maintain seal due to excessive stomach fluids. Skin extremely irritated
  • December 12th: Readmitted with Enterocutaneous and Biliary problems, unable to cope at
    home with abdominal wound drainage. Fistula & Wound Pouch changed on admission
15th December 2010
  • December 15th: Top wound approx. 4 cm x 4 cm and bottom two wounds measuring approx. 1 cm (l) x 0.5 cm (w) & 0.5 cm (l) x 0.5 cm (w)
  • This was followed on December 17th by a sonogram
  • On December 19th she had a pancreatic drain removed and then a CT scan of her abdomen.