Chronic enterocutaneous fistula: management in the community setting
Despite being aggravating and potentially embarrassing, enterocutaneous fistulas can be successfully managed, with patients being able to resume many of their normal daily activities while the fistula continues to drain. Nevertheless, the management of enterocutaneous fistulas in the community can pose many challenges to nurses, the most common being peri-fistula moisture-associated skin damage. This article presents fistula management plans, which can facilitate the long-term support of these patients, promoting patient comfort and adherence to treatment.
A fistula has been described as an abnormal communication between two epithelial surfaces (Burch, 2011). One example is a join between the bowel and the skin, which is known as an enterocutaneous fistula. Unlike an ostomy, where site selection and surgical creation of the stoma optimise the conditions for pouch application, fistula sites are not created intentionally (Willcutts et al, 2005) and often occur in wounds or along skin folds, to which adherence of an appliance can be problematic. There are many reasons why enterocutaneous fistulas occur. Factors that increase the risk of postsurgical fistula formation include (Reed et al, 2006):
Burch (2011) stated that postoperative complications are the most likely cause of fistula development, but the incidence is often under-reported as they are considered surgical failures.
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