Executive Summary: Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) Nursing Best Practice Recommendations

Abstract

Enterocutaneous fistulas (ECF) and enteroatmospheric fistulas (EAF) pose significant quality-of-life concerns for patients, and management challenges for the interprofessional healthcare team. In 2009, the Canadian Association for Enterostomal The developed best practice recommendations for the management of ECF. Over time, evidence and practice evolve, and the Nurses Specialized in Wound, Ostomy and Continence Canada performed a comprehensive review of the literature and revised the practice recommendation document. The revised recommendations provide evidence-based management guidance for ECF and EAF in the adult population whether in acute care, community/home care, or long-term/residential settings, and are specifically created for nurses. The revised recommendations include organizational support, assessment, nutrition, pharmaceutical management, education, and local fistula management. This article serves as an executive summary for this clinical resource; the full guideline is available at http://nswoc.ca/ecf-best-practices/

A New Extraperitoneal Method for Entero-atmospheric Fistula Closure Using a Free Muscle Flap

“…EAF management is a difficult problem as the control of output can be considerably problematic. 1 , 3 A poorly controlled EAF is a source of embarrassment, pain, and discomfort, but also results in high costs due to a tremendous use of disposable medical equipment. 3 Absence of overlying skin or soft tissue precludes spontaneous closure.…”

“… 1 , 3 A poorly controlled EAF is a source of embarrassment, pain, and discomfort, but also results in high costs due to a tremendous use of disposable medical equipment. 3 Absence of overlying skin or soft tissue precludes spontaneous closure. 2 Definitive surgery is not advised until 3–6 months after resolution of sepsis, malnutrition, and other injuries as this is associated with lower recurrence.…”

Getting Ready for Ostomy Certification

“…Next steps include defining the fistula anatomy, minimizing fistula output, containing the effluent, skin protection, and nutritional support. Collaboration between the patient, family, and the interprofessional team is essential in facilitating a comprehensive and effective approach to care 1,2…”

“…While somatostatin and its synthetic analogue, octreotide acetate, can decrease both fistula output and fistula closure time, neither drug has been shown to reduce mortality 1,2,4. Long-term use of octreotide has been associated with villous atrophy and acute cholecystitis and should only be used in the short term 1,2,4. Indicators of progress to closure include a decrease in fistula effluent, with increased fecal output distally through the stoma or rectum.…”

“…Fistulae pose significant quality-of-life concerns for patients and management challenges for the interprofessional health care team 2. They are one of the most challenging and rewarding situations that the WOC nurse encounters.…”