Treatment of a premature baby with an ileostomy and mucous fistula
Case study submitted by: Chantal Leduc, ET Nurse, CHU Sainte-Justine
Patient history:
2 month old male patient, born premature with many health problems
Temporary Ileostomy & mucous fistula as a result of Necrotizing Enterocolitis (NEC).
Assessment: 3rd December 2010
Stoma measures 22mm x 13mm
Oval, red in colour and slightly protruding
Ileostomy is situated in the surgical line with a mucous fistula and a Penrose drain
Currently using Hollister Pouchkins 3778 and Adapt Paste for the Ileostomy, Pouch 3778 used for the Penrose drain
Current weartime is 3 days.
Assessment: 7th January 2011
Since the last assessment, the leaking abdominal wound has dehisced and has caused the flange to come away, resulting in irritatation to the peristomal skin without any skin loss
The weartime is now around 2 days
Have decided to use Aquacel on the midline incision along with transparent film. Eakin Cohesive Slims® are then used around the ileostomy and the Penrose drain as well as 2 x 3778 pouches
The nursing staff have stressed that they would like a minimum weartime of 48 hours as it takes 1hour 15minutes to complete the pouching process.
Assessment: 10th January 2011
There is now less irritation around the ileostomy. However, output from the drain has increased so the skin is irritated around this area
The AQUACEL® dressing is saturated under the plastic film
Pouching system is holding well and weartime is 3 days
Will now use Dimethicone, Eakin Cohesive® Slims will be placed around the ileostomy and drain as well as on the healed abdominal wound to create a level surface. Transparent film will be used to hold the drainage bags.
Management: 10th January 2011
1. Irritated skin
2. Applying Cohesive® to drain
3. Applying Cohesive® to abdominal wound
4. Cohesive® to heal the skin
5. Pouch the drain site
6 .Apply Cohesive® to ileostomy
7. Pouch the ileostomy
8. Apply Tegaderm film to hold pouches in place
Assesment: 31st January 2011
Product combination is performing well and no changes are needed to the current care plan.
31st January 2011
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