Enterocutaneous fistula : Patients', families' and healthcare professionals' experiences - epidemiology and outcomes

Abstract

Introduction: Enterocutaneous fistula is a rare and complex condition with high morbidity.The condition causes multiple health problems, and it is both physically and psychologically demanding for the affected person and their families. Infection, fistula wound care challenges, electrolyte and fluid imbalance, and malnutrition render the individual in need of long periods of in-hospital care and homecare. This also places great demands on healthcare professionals and knowledge among healthcare professionals can be lacking. The patients have different needs and person-centred care is one way to promote individualised care based on the patient's specific needs. Research about how enterocutaneous fistula affects the individual and their families is scarce, and healthcare professionals often have little experience providing care for these patients. There is also a lack of population-based studies on enterocutaneous fistula.The annual incidence of enterocutaneous fistula was 1.87 per 100.000 persons. Cumulative enterocutaneous fistula related in-hospital care, until closure or end of follow-up, was median 4 (range 0-61) weeks. Thirty-seven per cent of the patients needed parenteral supplementation and 80% needed help with fistula wound care. Home-based healthcare, i.e., fistula wound care, resources for parenteral feeding and access to 24-hour emergency wound care at home, was provided to 42.2% of the patients. Estimated overall mortality at one, three, and five years was 33.7%, 42.1%, and 47.6%, respectively. Mortality was dominated by patients who did not have spontaneous closure of the enterocutaneous fistula or undergo reconstructive surgery.Conclusions: Enterocutaneous fistula is a serious condition with a high overall mortality and the patients need a lot of healthcare resources. The condition restricts the patient's and family's daily life and leads to social isolation and psychological distress. By promoting person-centred care and patient participation, the healthcare professionals can strengthen autonomy in daily life and improve the patient's ability to cope with the situation. Regular team meetings of the multidisciplinary team, careful planning before discharge and providing person-centred care can facilitate the care process for everyone involved.

Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

“…Several studies highlighted that fistula output remains increased despite administering loperamide, an antidiarrhoeic. The studies conducted by Shover and Todorow 30 and Ballard et al 45 confirmed that octreotide and lanreotide inhibit the effect of gastrointestinal juices and lessen fistula output 30,35,39 …”

“…Parli et al 37 and Härle et al 38 both argued that opioid usage decreases gastric motility while somatostatin reduces gastric hormones 37,38 . Critical care nurses should provide emotional support by assisting the patients, ensuring comfort, and guiding them through their disease process 39 …”

“…37,38 Critical care nurses should provide emotional support by assisting the patients, ensuring comfort, and guiding them through their disease process. 39 The CCNs stated the frustrations in patients with ECF frequently developing infections. Participants verbalized patients experiencing wound leakages, which further excoriate the skin.…”

“…The studies conducted by Shover and Todorow 30 and Ballard et al 45 confirmed that octreotide and lanreotide inhibit the effect of gastrointestinal juices and lessen fistula output. 30,35,39 The participants indicated challenges experienced from lack of resources, such as a shortage of stoma bags. This challenge of shortage of good quality stoma appliances and shortage of stoma care staff was confirmed in a study by Down et al 46 The study by Erbe 14 indicated increased utilization of supplies such as stoma bags because of fistula being difficult to pouch.…”