The use of collagen and hyaluronic acid dressing in peristomal wound care

Miss Sunny Wu1
1RPAH, Camperdown, Australia

Aim: The aim of this poster is to review the use of a collagen and hyaluronic acid pad (Hyalo 4 Regen®) as a treatment option for the complication of a peristomal  wound in order to reduce hospital length of stay and expedite discharge home.

Body: Mrs W is a 64 year old female who underwent a Hartmann’s procedure with formation of a colostomy. A mucocutaneous separation was developed. It quickly deteriorated and was highly suspicious  as pyoderma gangrenosum.

Mrs R is a 64 year old female who underwent a right hemicolectomy with abcarian ileostomy formation. She developed a peristomal wound post-operatively.

Both of the patients were delayed for discharge because of the complications of peristomal skin. Then, the collagen and hyaluronic acid dressing was commenced as a primary dressing for both patients.

Conclusion: Mrs W’s peristomal wound was from 7 to 10 o’clock. The wound extended from stoma edge measured  2 x3 x2.5 cm. The shallow wound from 2 to 5 o’clock measured  1 x3 x 0.2 cm. After being treated with the collagen and hyaluronic acid dressing for 4 weeks, pt was discharged with this dressing.  6 weeks later, pt’s peristomal wound was epithelialized.

Mrs R’s peristomal wound at 9 o’clock measured 1 x1 x 1 cm. After being treated with the collagen and hyaluronic acid dressing for 3 weeks, the wound had completely granulated and had started to epithelialize. Pt was discharged soon after.


Biography:

Sunny Wu is a practising registered nurse at Royal Prince Alfred Hospital which is a designated centre for Pelvic Exenteration and Peritonectomy.  She has been nursing for 5 years with 3 years’ experience as a Colorectal Nurse. Currently, she is a master’s student of the Advanced G. I. Surgical Nursing Program at RPAH, and has been working in stomal therapy for the past year.

Bedside treatment of complex open abdomen

Ms Betty Brown1
1Royal Prince Alfred Hospital/Royal North Shore Hospital, Newtown, Australia

Care of a patient who had undergone 13 laparotomies for bowel obstruction and bowel perforation, with repeated failed attempts at ileostomy formation which resulted in multiple dehiscence and fistula formation.  He was transferred to our facility with short gut syndrome of ~ 150 cm bowel remaining, 4 perforations/fistulae, and grossly oedematous small bowel submerged in 2 litres of enteric bowel contents.

After debridement, Negative Pressure Wound Therapy (NPWT) was used with multiple contact layers to protect and separate the bowel.  After NPWT seal was obtained, fistula wound pouch was applied over the 4 fistulae to separate and monitor effluent. Dressings were changed 2-3 times weekly at the bedside with analgesia.

Patient developed complication of aggressive rare fungal infection within wound bed, treated with Veraflo therapy using hydrogen peroxide and aggressive serial surgical debridements.

Patient also had behavioural and family social issues which made his treatment and recovery challenging, and left against medical advice after 458 days of hospitalisation.

NPWT was continued until the wound was suitable for delayed primary closure and skin grafting.  He is now subsequently 95% healed and is now wearing a simple high output pouching system over his single fistula which had self-stomatised.


Biography:

Betty graduated with a Bachelor of Nursing on the Dean’s Honour list, from the University of Manitoba, Canada, in 2004.  She obtained her WOCNCB board certification in wound, ostomy, and continence nursing in the USA in 2010.  She has since worked as a wound and ostomy specialist nurse at top ranked hospitals including Johns Hopkins, Stanford University, Cleveland Clinic Abu Dhabi, Franciscan Health System, and  currently at Royal Prince Alfred Hospital and Royal North Shore Hospital in Sydney.  She has extensive experience in complex wound, ostomy, and fistula management, and is currently completing her Masters of Wound Care at Monash University, Victoria.

Tu Meke te Peke Ki Ahau – the bag is great to me

Mrs Anna Veitch1, Mrs Lorraine Andrews2
1Tairawhiti District Health Board, Riverdale, New Zealand, 2Omnigon, Epsom, New Zealand

A fistula is defined as a connection between two epithelialized surfaces.  Although rare in general practice, colovaginal fistulas are not uncommon in stomal therapy nursing.  Such a presentation is often post initial review by a gynecology service.

This distressing condition is often accompanied by a significant psycho-social morbidity. That morbidity can be demonstrated as social dis-engagement or intentional social isolation, lower quality of life (QOL) and interpersonal stress in relationships.

This poster follows the care of Mary (pseudonym) who struggled with a colovaginal fistula and all it’s consequence for many years before seeking treatment involving a stoma.  In spite of  her dread of having a stoma in her life and the challenges it presented  the bag was great to her.


Biography:

Anna first qualified as a Registered Nurse in 1987 and completed her Post Graduate Certificate in Stomal Therapy though the New South Wales College of Nursing in 2006.  She works across the hospital community interface in Gisborne provided continuity of care for both continence and ostomy clients.

Anna believes that stomal therapists are in the unique position and privileged position of being able to provide care across the life span and often for the whole life.  She is passionate about making a difference for this client group which often includes facilitating recovery and rehabilitation to a new normal.

Nothing prepared us for Mr M

Mrs Rachel Pasley1, Mrs Lorraine Andrews2
1Northland District health Board, Whangarei, New Zealand, 2Omnigon, Epsom, New Zealand

A significant portion of Rachel’s client base are from a lower soci-economic group having high health care needs with limited resources and low heath literacy skills. Rachel remains passionately committed to delivering a high quality service utilizing outstanding advocacy skills.

Accounting for 8% of ostomy skin issues granuloma lesion are a relatively common finding in stomal therapy practice.  While not always problematic , once established if not treated the commonest pathway is for them to enlarge until they cause pouching issues, skin damage and bleeding.  Remarkably ostomates will often tolerate hypergranuloma lesions without reporting them until bleeding becomes an issue.

This poster will present the care we provided to Mr M, who presented once he was desperate and experiencing significant bleeding from what were initially un-identified lesions.

Nothing prepared us for the issue Mr M revealed when he removed his appliance.


Biography:

Rachel is a community STN practicing in the culturally diverse region of  Northland.  She delivers stoma care to over 400 clients spread over a wide geographical area.  Rachel initially registered as an Enrolled Nurse in 1989 before completing her Registered Nurse program in 1994.  She completed the Post Graduate Certificate of Stomal Therapy Nursing in 2008.

 

Finding the right fit

Ms Kate Brereton1
1St John Of God Murdoch , West Leederville, Australia

A demonstration of pre-surgery assessment of a prospective colostomy patient using expert clinical skills to determine the appropriate stoma pouch selection.

Mrs S, a 64-year-old woman, was to have an elective abdominoperineal resection.

On meeting Mrs S a severe tremor in her hands, and altered gait was obvious. Mrs S stated the reason for her foot drop and upcoming colostomy surgery was  complications of spinal surgery that had led to her becoming incontinent of urine and faeces. Her tremor was due to Parkinson’s disease. She presented as eager for information about colostomy as she was obviously distressed about the faecal incontinence and the impact this had on her life and particularly on her husband. Mrs S looked forward to having a stoma to control her faecal incontinence and was motivated to be independent and self-caring post-surgery. She was keenly interested in the education provided and welcomed to opportunity to view stoma appliances and “try them out”.

The patient and the stomal therapist seized the opportunity for pre-surgery assessment and evaluation of the patient’s physical capabilities and limitations. Mrs S was given a variety of appliances with explanations about the key features each product. The STN assessed her ability to utilise these stoma appliances while she manipulated them, to predict which stoma appliance could work best for her.

Assessment post-operatively revealed a soft abdomen with an imperfect stoma, plus her marked tremor, which highlighted the importance of identifying essential features of the stoma appliance in order for the patient to achieve independence with stoma management.


Biography:

As a stomal therapist for 7 years I have a passion and an interest in the education an appropriate counselling for my stoma patients. I work as a stomal therapist at a large private hospital in Perth Western Australia that provided services to both metropolitan and rural clients.

 

 

Effects of functional dressing for donor-site wound: A meta-analysis

Miss Shimin Liu1, Mrs Huiyi Tan2, Mrs Haiyan Li2, Miss Piaopiao Zhu1, Mrs Xuemei Ye2
1Jinan University, Tianhe District, Guangzhou City, Guangdong Province, China, 2GUANGZHOU RED CROSS HOSPITAL, Haizhu District, Guangzhou City, Guangdong Province, China

Objective: To evaluate the clinical effect of functional dressings applied to the donor site wounds using meta-analysis. Methods: Computer search PubMed, Cochrane Library, Web of Science, Ebsco, Chinese Journals Full-text Database, Wanfang Database, VIP Database, search date for the database from the self-built library up to April 2018, published in the relevant functional dressing treatment Literature on the wounds of the donor area. The measurement indexes were wound healing time, infection rate, and scar growth. Revman5.3 software was used for meta-analysis. Results: A total of 13 articles were included, including 984 patients and 1057 wounds. In the functional dressing group, the wound healing time was shorter than that of the traditional dressing group, with mean difference -2.31 (with 95% concordance interval -2.67~-1.94, P<0.00001). The incidence of wound infection in the functional dressing group was lower than that in the traditional dressing group, with relative risk (RR) 0.22 (with 95% confidence interval 0.10~0.51, P=0.0004). The scar score in the functional dressing group was lower than that of the traditional dressing group, with mean difference -1.06 (with 95% concordance interval -2.31~-0.89, P<0.00001). Conclusions: Compared with traditional dressing, functional dressing can accelerate wound healing, reduce infection rates, and reduce scar hyperplasia. Due to the quality of the included studies and sample limitations, the above conclusions still need to be verified by more high-quality research.


Biography:

Bio to come

 

PEG in – PEG out

Mrs Lorraine Andrews1, Mrs Theresa Needham2
1Omnigon, Epsom, New Zealand, 2Taranaki District Health Board , Westown, New Zealand

Percutaneous endoscopic gastrostomies represent the intentional creation of a fistula connecting the stomach to the skin.  The definition of the word stoma is literally “a hole” yet the fistulas and skin complications associated with PEG’s seldom preset to the stomal service.

This series of two posters presents the care of Vanessa (PEG in) and Charles (PEG out).

Vanessa has lived with PEG feeding for 5 years.  Over the that time  she has been tormented by persistent tube site leaking resulting in a deeply eroded / ulcerated site which is extremely painful and reduces her quality of life. Vanessa’s poster demonstrates what can be achieved when patients and nurses work as a team, have good product knowledge and are willing to think outside the usual practice parameters.

After 25 months of PEG feeding and now post device removal Charles lives with persistent gastrocutaneous fistula causing consistent leakage, painful eroded skin and reducing his ability to complete his remaining life goals.  Living very rurally and with limited access to professional care Charles and his wife have demonstrated a high level of innovative skill in restoring his QOL.

Hoping that their experiences with help others both Vanessa and Charles contributes to the posters.


Biography:

Theresa currently works as a community District Nurse in rural Taranaki.  She transitioned into community nursing from in hospital surgical  nursing concerned that she would lose clinical skills and be under challenged. The reality of community nursing has proven to be the exact opposite requiring high level assessment and intervention planning.

Theresa believes she is blessed to have found her ideal job while serving her community.  She practices from a holistic patient focused prospective and passionately believes in continued learning and sharing of knowledge.

As well as nursing Theresa assists in managing a farm with her husband.

Stoma education for the older person is about keeping it simple as 1, 2, 3

Mrs Rebecca Howson1
1Alfred Health, Bayswater, Australia

Australia’s aging population presents unique hurdles when planning, providing care and educating new ostomate’s; and these variations to care differ greatly depending on the individual. Whilst there are many predictors to flag potential issues, and well planned out pathways for the stoma’s physical journey; this is aimed at highlighting the often overlooked and under documented complexities encountered as we navigate patients in the transition to home. This is an example of how not all complications and barriers to discharge are due to the stoma, the output, or any medical issue. It is about the patient’s ability to self-manage. This follows the journey of a non-English speaking background patient transferred from the acute setting to Rehabilitation. She was struggling to manage her colostomy appliance, which could put her and her husband with dementia into residential care. The ability to self-manage a stoma is often the defining factor to an aged person’s ability to return to their lives at home or placed into formal care. Her motivation to prevent placement was demonstrated by her readiness to learn. As a Stomal Therapy Nurse, it is our responsibility to identify the barriers to self-care, adapt product selection and implement the most achievable goals. The patient’s specific goals and the interventions produced to achieve these; were individualized so that she is able to return home to continue to live her life; and not dictated by her new stoma. This idea meant that the concept of self-care had to be as simple as 1, 2, 3.


Biography:

A registered Nurse since 2011 working in the Colorectal ward at the Alfred and Enrolled Nurse since 2007, in aged care; I have always had an affiliation with working with the older person and patients with Stomas. This history meant when i was looking to continue with my Studies that Stomal Therapy seemed like an appropriate choice.

Since completing The Graduate Certificate in Stomal Therapy in 2016, I have been working as the Stomal Therapy C.N.C in Caulfield Hospital, a Sub-acute Rehabilitation center which includes: slow stream(Aged Care), Fast stream, aged psychiatry and a specialized Acquired Brain Injury unit.

 

Case Study: V.A.C ® therapy management of a complex ventral abdominal wound

Miss Kelly Vickers1
1Lyell McEwin Hospital, Elizabeth Vale, Australia

Introduction: Vacuum Assisted Closure (V.A.C®) Therapy has become a common wound care practice used in the treatment of surgical wounds, ulcers, skin grafts, burns, diabetic feet & fistulae. With its increasing use, particularly on complex wounds, clinicians sometimes need to adjust how it is used to ensure a positive patient outcome is achieved.

Background: A 65- year old female required a Hartmanns Procedure for a colovaginal fistula secondary to a diverticular perforation.  Complications such as a retracted stoma, wound breakdown and intra-abdominal sepsis lead to a further five surgical operations, resulting in a large ventral defect beneath the open wound. Other factors such as obesity (BMI 36.6kg/m2) and leaking stoma appliances further complicated her management.

Method: The large, irregular surface area of the wound, meant that V.A.C ® therapy was the most ideal option to heal this wound, but the large ventral defect in the abdominal fascia limited the use of high-pressure V.A.C ®, for fear of causing an enterocutaneous fistula. Using clinical judgement, low pressure V.A.C® therapy was initiated.

This case study outlines the challenges encountered when using V.A.C.® Therapy at low pressure suction, and the solutions created for successful wound healing.

Conclusion: By adjusting the application of low-pressure V.A.C ® to this abdominal wound, dressing leakages were prevented and attended to every 48-72 hours on the ward instead of being completed in the operating theatres. Initially it was planned for the patient to have a skin graft to the wound, but the wound healed without this additional surgery.


Biography:

Bio to come

Pay it forward

Mrs Julie Skinner1, Mrs Lorraine Andrews2
1Waitemata Distrint Health Board, Takapuna , New Zealand, 2Omnigon, Epsom, New Zealand

In 2003 Julie and her family emigrated to New Zealand.  Julie was appointed as  sole Stomal Therapist in the 600 bed Northshore Hospital where she completed the Post Graduate Certificate of Stomal Therapy Nursing.   When the community Stomal Nurse Specialist position became vacant Julie   combined a passion for Stomal Therapy with community nursing.

Ensuring that a person can end life with some dignity and in accordance with their personal values system is the final act of caring that a nurse can offer a family. To be facing the end of life while also learning the skills needed to manage a new stoma would seem to be double jeopardy with the potential to destroy any quality of remaining life.

Stomal therapy practice is unique in its involvement with patients long term and across the life span.  While each day presents many varied and new challenges the opportunity to make a difference is always a privilege.

This poster will present the end of life care of Harry and Rose.  Both Harry and Rose developed abdominal wall metastasis around their stomas.  The tumour growth and the challenges of adhering a pouch for effective containment on an abdomen with topography which changed almost daily, definitely had an impact on the quality of life Harry and Rose  had in their final weeks of life.

The poster will also explore the ways nurses learn and how their experiences influence their future practice.


Biography:

In 1984, in the UK Julie commenced her nursing career  registering as an Enrolled Nurse.  While raising a young family Julie worked as a casual nurse and developed a passion for both surgical and stomal nursing.  In 2000 she  became a Registered Nurse.

 

12

AASTN

This conference is proudly hosted by the Australian Association of Stomal Therapy Nurses: www.stomaltherapy.com

One of the Association's major objectives is the promotion of quality care for a wide range of people with specific needs. These needs may be related to ostomy construction, urinary or faecal incontinence, wounds with or without tube insertion and breast surgery.

Patients/clients across the life span are provided with preventative, acute, rehabilitative and continuing care as required. Another objective is the maintenance and improvement of professional standards in relation to Stomal Therapy Nursing Practice to the highest degree possible. Recognition of the need for and encouragement of the development of specialist expertise in the field of Stomal Therapy Nursing underpins the Standards for Stomal Therapy Nursing Practice.

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