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

Assesment: 31st January 2011

• Product combination is performing well and no
  changes are needed to the current care plan.