ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Fistula treated with Negative pressure wound therapy.

Updated on January 21, 2011

Different fistula different technique

This hub  about fistula treatment is only meant  for professionals preferably in a hospital or wound care clinic. However, if you have a fistula that is difficult to treat it may be of interest for you to know about this relatively new method of treating.

I will not be posting photos for this one as i do on many of the other hubs.

Hopefully the step by step techniques will be understood perfectly by health care workers already familiar with using negative pressure or vacuum machines in their practice.

Some of you may have seen these techniques before as i have sent them out and taught them in many hospital wards around the world.

Before you read further i am assuming that you know what a fistula is and aware of the importance of correct care.

Negative pressure must never be applied directly to this type of wound without taking the necessary precautions. If you do apply it directly you are in danger of perforations! Please treat these wound with the utmost of care.

Do not let this frighten you though as i have seen many successes using NPWT.


This fistula is not within another wound and classified as a simple fistula.

Treating with Vacuum therapy:

  • Clean the skin and wound , remove any type of oil or grease from the skin.
  • Apply skinprep if preferred.
  • Explore the fistula and use NAG which is a non adhesive gauze in the end of the fistula if needed
  • Place hydrocolloid around the opening of the fistula at least 4cm around the edges.
  • Depending on the amount of exudates use a channel drain directly into the fistula.
  • If you are unsure of the depth and the wound is exudating more than normal use follow instructions for a complex fistula. If it is not too heavy and you are still concerned you can cover the channel drain with a layer of Non adhesive gauze ( NAG ) for protection. (As the drainage decreases the NAG can be replaced by AMD halfway down the drain but continue with NAG on the tip )
  • Fill the wound cavity if needed with AMD gauze and cover with transparent dressing.
  • Apply negative pressure in accordance to the clinical guidelines or the physicians prescription.
  • Observe carefully the colour and amount of exudates each day .
  • Observe the patient in relation to pain experience, this should not be worse than they experienced before the NPWT was applied.
  • Observe for any swelling near or around the fistula, for example, if a lump should appear on the skin near the wound then suspect tunnelling or a new fistula opening. This is called the tunnel effect and is seen when the pressure is sucking on a new wound which has a very tiny opening. Stop treatment and contact the physician immediately. ( I have only ever experienced this twice and it was not a side effect of Vacuum therapy, but instead it was the therapy which was able to show up a very ugly hidden wound which was not noticed on examination. The only thing that can be done here is an extensive debriding of the wound. )


This type of fistula is within a wound

· Cover the mouth of the fistula with several layers of petroleum based gauze

· Thoroughly irrigate and clean the abdominal wound

· Now remove the layers of gauze from the mouth of the fistula

· Cover the opening of the fistula with one layer of NAG

· Cover any other exposed areas of exposed bowel or organs with several layers of NAG ( Minimum 4 )

· Gently place 2 layers of AMD over the NAG making sure that this stays in place.

· Place a flat dran onto the AMD and fill with AMD over the drain

· Fix the drain firmly with strip paste ( a strip of paste which is used around stomi openings ) at the edge of the wound .

· If there is maceration around the edges of the wound use hydrocolloid for protection before fixing the strip paste.

· The pressure should be no less than 80mmHg.

· Always use continuous therapy and follow the observations above.



Method 1 using a drainage tube:

· Cover the mouth of the fistula with minimum 3 layers of petroleum based gauze.

· Thoroughly irrigate and clean the wound cavity.

· Remove the layers of petroleum based gauze.

· Place a drainage tube (such as a foley catheter in our case we can use a 19fr round drain) over the mouth of the fistula but DO NOT enter the lumen of the bowel.

· Take a strip of petroleum based gauze and wrap this around the base of the drainage system and around the mouth of the fistula which will form a seal.

· Cover any exposed organs or bowel with several layers of NAG.

· Use a flat drain and place this about 1cm from the drainage device.

· Fill the rest of the cavity with AMD after fixing both the drainage device and the flat drain at the exit of the wound. ( Can be placed together or on either side, better on either side to prevent air leakage ) It is important that the extra drainage tube stays firmly in place as this will help remove the infectious exudates from the fistula before it is sucked into the AMD)

· Connect both the drainage system (our 19fr ) and our suction device (the flat drain) to a Y connector and connect to the 800ml canister.

· Negative pressure continuous at minimum 80mmHg.

· Observations as above.

Method 2 using a pouch:

· Cover the mouth of the fistula with 2-3 layers of petroleum based gauze.

· Irrigate and clean thoroughly.

· Remove these layers of gauze.

· Wrap NAG around the mouth of the fistula and cover any exposed organs or bowel with NAG.

· Place AMD in the rest of the wound but DO NOT place this over the mouth of the fistula.

· Insert a 19fr drain between the layers of AMD but not too close to the fistula opening(curl the drain around the edges )

· Place a doubled piece of 4”x4” ( now 2”x2” )NAG over the fistula opening.

· Place transparent film over the wound dressing as normal.

· Make a mark on the transparent film directly over the mouth of the fistula.

· Apply pressure for a few minutes.

· Now turn off the pressure again and allow the dressing to relax.

· Carefully cut away the transparent film over the 2”x2” NAG dressing which was placed over the mouth of the fistula.

· Remove the NAG and expose the chronic fistula.

· Apply a good barrier ring of strip paste on the transparent film around the fistula.

· Apply an ostomy device of your choice directly over the exposed fistula and the ring of paste.

· Make sure that the device is securely placed and that the appliance is adequately sealed.

· Apply negative pressure at 60mmHg.

· Observe for any dressing pulling down over the mouth of the fistula.( As the air is extracted from under the transparent film the drainage device may shrink and pull together. Just simply pinch the bag and hold it away from the mouth of the fistula during the application of negative pressure)

· Use continuous pressure and make sure that there are no breaks or pauses in the treatment. This type of wound needs 100% compliance.

· In addition to observations above, remember to change the ostomy bag before it is full. When changing this turn off the V1 and clamp.

· Observe on each shift for clamped tubes!


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)