Schlagwort: Wound Pouch

eakin Wound Pouches™ provide a humane way to manage fungating tumours

Wound pouches in use

eakin Wound Pouches™ provide a humane way to manage fungating tumours

Submitted by Elisa van de Ree, Community nurse SVRZ ZorgThuis, The Netherlands

Patient History

75-year-old lady with previous diagnosis of  breast cancer in 2004 resulting in a mastectomy, and a successful programme of treatment.

September 2018

• Diagnosis of sarcoma on the site of mastectomy. 

• Terminal diagnosis with prognosis of approximately 6 months, care focused on patient comfort. 

• Expectation that the tumour will continue to grow larger. Patient treated with radiotherapy to keep the skin flexible for tumour growth. 

• Doctors indicate that there is a high risk of bleeding and sarcoma in blood vessels.

• Patient managing at home with help from her husband.

May 2019 – August 2019:

• Tumour growing rapidly, and the community care team is appointed to care for the patient.

• Tumour grows larger every month and wound care becomes increasingly difficult.

• Wound care from the community team is expanded to twice per day.

• Tumour continues to exude highly, and absorbent dressings become saturated quickly.

• Wound care is expanded to three times per day.

• The community care team find it difficult to care for the wound due to the growing tumour, tissue coming off, high risk of bleeding and the wellbeing of the patient.

September 2019:

• Leakage continues to be extremely problematic and the patient suffers constant wet clothing and bed linen. 

• The three-time daily dressing changes cause considerable physical discomfort and anxiety for the patient, her family and carers.

Solution

To find a more appropriate product that would provide greater wear time and comfort, the community care team contact eakin® who recommend use of our extra-large eakin Wound Pouch™ (839263).

They visit the lady’s home to educate the nursing team on how to fit the eakin Wound Pouch™ to this very challenging wound, causing minimal disruption to a very ill patient.

Step-by-step guide to fit an eakin Wound Pouch™

Use eakin release™ adhesive remover to remove previous application. Clean and dry skin.

In this case, and in an effort to reduce waste, the cut-out section of eakin Cohesive® material was reused alongside eakin Cohesive SLIMS® and eakin Cohesive StomaWrap™ to fill all dips and crevices and create an even pouching surface.

Remove the white release paper and apply to the wound. Use gentle pressure to ensure good adhesion.

Please remember when reusing cut-out sections of eakin Cohesive® from
eakin Wound Pouches™ to peel away the medical film prior to use.

Result

After suffering three-time daily dressing, clothing and bedding changes,
the eakin Wound Pouch™ achieved a wear time of 3 to 4 days without leakage.

The community care team no longer had to interfere with the wound multiple times a day which meant that disruption to the terminally ill patient was significantly reduced.

The eakin Wound Pouch™ successfully contained unpleasant odour and wound exudate, considerably reducing the need for clothing and bedding changes.

The eakin Wound Pouch™ provided comfort to the patient and contributed to improving the emotional well-being of both the patient and her husband.

Conclusion

Unfortunately, the condition of the patient deteriorated rapidly and she passed away on the evening of 30th September 2019.

The community nurses were pleased to avail of the eakin Wound Pouch™, with the patient’s husband commenting that it had been a great solution for his wife.

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eakin Access Windows™ provide instant access

Eakin® Vertical Incision Wound Pouch with window
Wound pouches in use

eakin Access Windows™ provide instant access to wounds and fistulae without removing the wound pouch.

This case study looks at the use of eakin Access Window.TM

Ian Whiteley RN BN, STN, Grad Cert (Health Science, Nursing Education), Cert IV Workplace Assessment and Training, Australia

Case Study

• Enterocutaneous fistula developed following complex abdominal surgery. High output required extensive skin protection and drainage.

Enterocutaneous Fistula
14 days post closure of jejunostomy
Protecting peri-wound skin
Protecting peri-wound skin

• 839261 eakin Wound Pouch™ was an excellent size and shape for this wound and eakin Access Window™ allowed periodic inspection.

Eakin® Vertical Incision Wound Pouch with window
eakin Wound Pouch™
 
• eakin Wound Pouch™ was renewed every five days.

• Step by step photographic wound management chart left in patient’s notes to guide the ward nursing staff in the technique of changing the pouch.

 

Management of a complex open abdominal wound

Wound pouches in use

Management of a complex open abdominal wound

This case study looks at the management a complex open abdominal wound

Submitted by: Jeanette Fingren RN ETN, Colorectal unit Sahlgrenska University Hospital, Östra, Göteborg, Sweden

Patient history

• A 65-year-old gentleman, diagnosed with a rectal cancer.

• Had an abdominal perineal excision of rectum and formation of a permanent colostomy.

• Developed a large parastomal hernia.

• Decision was made to repair the parastomal hernia and re-site the colostomy to the right-side of the abdomen.

• Developed a small bowel obstruction after surgery which required another laparotomy.

• The wound dehisced and the bowel protruded through the abdominal wall.

The wound dehisced and the bowel protruded through the abdominal wall.
The wound dehisced and the bowel protruded through the abdominal wall.

Care Management Plan

An eakin Wound PouchTM was used to collect the effluent from the high-output enterocutaneous fistula as it was the most cost-effective, clinically efficient and effective wound management option for the gentleman. eakin Wound PouchesTM were selected as they can be used for large complex wounds and fistulas with no adverse effects such as secondary infection.

eakin Wound Pouches<sup>TM</sup> were selected as they can be used for large complex wounds and fistulas with no adverse effects
eakin Wound PouchesTM were selected as they can be used for large complex wounds and fistulas with no adverse effects
An eakin Wound Pouch<sup>TM</sup> was used to collect the effluent from the high-output enterocutaneous fistula
An eakin Wound PouchTM was used to collect the effluent from the high-output enterocutaneous fistula

 

 

 

 

 

 

 

 

Outcome

• eakin Wound PouchTM efficient and effective.

• No adverse side-effects.

• Patient comfortable.

• Patient wellbeing maintained.

• Low-cost solution.

After 10 months, the abdomen was closed without complication and a colostomy formed on the left side of the abdomen.
After 10 months, the abdomen was closed without complication and a colostomy formed on the left side of the abdomen.

Management of an Enteroatmospheric Fistula

Wound pouches in use

Management of an Enteroatmospheric Fistula

This case study examining the use of eakin Wound Pouches™, eakin Cohesive® paste and eakin Cohesive® skin barriers in managing an open wound and enteroatmospheric fistula.

Submitted by: Lawrence Ikahu, Clinical Practice Consultant – Continence and Stoma Care, Aga Khan University Hospital, Nairobi, Kenya

Patient History

• A 72-year-old gentleman.

• Intestinal obstruction and a parastomal hernia.

• An interventional laparotomy was performed but the patient was left with an open abdomen.

• Later developed an enterocutaneous fistula.

• The enteroatmospheric fistula was being managed by negative pressure wound therapy (NPWT) with little success.

Before
Before

Care Management Plan

The new care management plan involved use of an eakin Wound Pouch™ which facilitated the maintenance of moisture around the wound while allowing fistula output to drain, avoiding leakage. eakin Wound Pouches™ were used for 3 weeks in hospital. The patient was discharged home with the eakin Wound Pouch™ being changed every 2 days. A combination of eakin Cohesive® skin barriers, eakin Wound Pouches™ and eakin Cohesive® paste were used to protect the surrounding skin. The eakin Wound Pouch™ facilitated wound healing, ensured accurate measurement of output and did not hinder the gentleman’s mobility. Progress over the following month was impressive.

The wound reduced markedly in size from a 10 cm diameter to a 2 cm diameter, meaning wound closure was imminent. There were two options available for closure; either allow the small wound to close naturally or for the plastic surgeon to create a muscle flap.

During
During

Conclusion

• Fistula output could be monitored.

• Accurate fluid measurement.

• Patient discharged home.

• Patient able to be mobile.

• Odour Control.

• Home nurses only needed to attend every 2 days.

After
After

Management of a faecal fistula in an abdominal wound

Wound pouches in use

Management of a faecal fistula in an abdominal wound

This case study looks at the management of a faecal fistula in an abdominal wound

Submitted by: Kylie Leavy STN, Dandenong Hospital, Victoria, Australia

Patient background

• 44 year old lady who presented to Dandenong Hospital on the 15th of April 2015 with a diagnosis of Pseudomembranous Colitis secondary to Salmonella.

• Proceeded to theatre and she underwent a laparotomy, subtotal colectomy, formation of an end ileostomy and ventral hernia repair.

• Day 9 post op she returned to the operating theatre and had a repeat laparotomy, drainage of intra-abdominal abscess and revision of her ileostomy.

• Day 24 post op she returned to theatre for the third laparotomy with abdominal wash out. Abdomen was left open as a laparostomy wound.

• It was noted at each surgery that the bowel was very friable which resulted in the formation of a faecal fistula in the wound.

This case study outlines the management of the patients wound and fistula during her 426 days in hospital and the strategies used in the attempt to discharge during this time.

Care Management Plan

• eakin fistula appliance (839265) with continuous irrigation (50 ml per hour) and continuous suction (Clements wall suction 100mmhg).

• This system was changed PRN depending on the varying volumes of output from the ileostomy and fistula.

• Wound care training was provided for the nursing staff in the ward to ensure continuity of care.

May 2015
October 2015
October 2015
December 2015
December 2015

As the wound healing continued, changes were made to the wound care management plan: the continuous irrigation was reduced to intermittent irrigation to encourage mobility and rehabilitation.

Attempts were made with the use of other appliances and suction omitted, but the very fluid output of about 1500ml per day from the fistula was problematic. The need for intermittent suction connected to the appliance was imperative to maintain a seal.

Preparation for discharge was coordinated with Hospital in the Home. it was necessary to explore avenues of portable suction devices. A Laerdal suction unit was purchased by the hospital.

The Stomal Therapy Team in the hospital created a step by step care plan to ensure continuity of care for an inexperienced community team.

Careplan

1. Use template on wound dressing to size and cut appropriate opening in the bag as shown below.

2. Protect the peri wound skin by picture framing with strips of Eakin cohesive.

3. Position the appliance appropriately.

4. Seal around edges of wound dressing with Opsite Flexigrid (allergy to Tegaderm).

5. Cut rigid connector off the bottom of the appliance.

6. Place suction tubing into the bottom of the fistula bag and secure with an elastic band.

7. Turn on suction for 5 minutes every 2 hours to clear bag of debris and faecal matter. The suction unit has a single on/off switch and the ability to control the level of suction by adjusting the dial on the left of the unit, if needed.

8. When suction not required, remove suction tubing and use the Alligator clip to seal the drainage bag (see below).

Outcome

The team worked together to nurse this lady at home, however due to the complex nature of the high output wound and an under resourced community team, the lady was readmitted to hospital for management. The care plan using the Eakin wound pouch was successfully continued until reoperation and repair.

The management of the fistula and surrounding wound was a challenge to all members of the multi-disciplinary team.

• Capacity to cope with the effluent.

• Skin protection.

• Comfortable in use.

• Flexible on the body which helped to encourage mobility.

• Option to attach to suction.