SKIN CARE MANAGEMENT OF GASTROINTESTINAL FISTULAS

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The development of a cutaneous gastrointestinal (GI) fistula creates a challenge for skin care management. The effects of continuous moisture on the skin and the degree of chemical irritation of effluent (depending on where the fistula originates in the GI tract) can severely compromise skin integrity. These factors may also lead to infection or impair wound healing if draining within an open wound.4, 5, 6, 7

The ongoing scenario for the patient with a draining fistula usually consists of odor, wetness, burning pain, and discomfort secondary to skin erosion. These conditions necessitate frequent dressing changes, which also create additional discomfort for the patient. Alteration in skin integrity not only impacts overall patient well-being and comfort but also medical-surgical and nursing management goals for the patient.

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GOALS OF SKIN CARE MANAGEMENT

The goals of skin care management are to maintain skin integrity and to contain the effluent. The ability to contain the effluent and divert it from the perifistular skin protects and heals irritated skin and surrounding wounds. Further, the ability to contain the effluent allows for accurate measurement of fluid and electrolyte losses and thus for the timely replacement of fluids and electrolytes and the maintenance of nutritional balances. Good mechanical control of a high-output fistula and

ASSESSMENT AND PLAN

The patient with a GI fistula must have an individualized plan determining which methods and materials are appropriate for optimal skin care management. In addition, availability of products, cost, knowledge of products, time, creativity, and technical skills of the caregiver must also be taken into account.

Irrang and Bryant4 developed a fistula assessment guide that identifies four major components to assess when determining skin care options for a patient with a GI fistula.

  • 1

    Origin of the

INTERVENTIONS AND METHODOLOGY

The decision of which method or product to use for each patient with one or several GI cutaneous fistulas may initially require a trial-and-error period and a period of close re-evaluation and modifications.

Bryant2 states that a good rule of thumb to follow when dressings are used to contain effluent and require changing more often than every 4 hours is to consider application of a pouch system. When dressings are being used to contain effluent, a protective skin barrier, either in wafer or

SUMMARY

The basic objectives of skin care management of GI fistulas are the prevention and management of skin breakdown and the promotion of healing of an open wound with a draining fistula by the containment of effluent. Skin or wound care management is one component of the overall medical-surgical management of patients with GI fistulas. This component plays a significant role in promoting patient comfort and well-being and mechanical control of unwanted drainage on the skin. When these objectives

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  • R. Bryant

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    Options in practice

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  • S. Irrang et al.

    Management of the enterocutaneous fistula

    Journal of Enterostomal Therapy

    (1984)
  • K. Jeter et al.

    Managing draining wounds and fistulae: New and established methods

There are more references available in the full text version of this article.

Cited by (0)

Address reprint requests to Jean L. Dearlove, CNS, RNC, CETN, Department of Surgery, State University of New York Health Science Center, 750 East Adams Street, Syracuse, NY 13210

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From the Department of Surgery, State University of New York Health Science Center, Syracuse, New York

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Copyright © 1996 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.