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When Complex Wounds Need Extra Care

Wound Care SpecialistsWhen our patients have a medical condition that requires a specialized expertise, their home care nurse will frequently turn to one of VNSNY’s nurse specialists for additional support and guidance. While VNSNY nurses are well trained to handle wounds that are healing normally, complex wound and ostomy cases require the knowledge that only an experienced certified wound ostomy continence nurse (WOCN) can provide.

As one of VNSNY’s team of five WOCNs, Mary F. advises VNSNY’s home care nurses on patients with complex wounds, including pressure ulcers, that need extra care, as well as those who have undergone ostomy surgery. During this procedure, part of the bowel or bladder (or both) is removed. The surgeon will create an opening for evacuation in their abdomen called a stoma, which requires skilled management to prevent infection or other complications, as well as education to help the patient adjust and become self-sufficient in their stoma care.

One of Mary’s recent consultations involved a 33-year-old woman named Marlene*, who’d had her large bowel and rectum removed. When the surgical wound in her abdomen didn’t close properly, fistulas formed. These fistulas protruded through her wound, causing the intestine’s contents to leak out before they reached her stoma.

Marlene had been hospitalized for six months. “I never thought I’d get home,” she told Mary during their first encounter. Once she was discharged into VNSNY’s care, her home care nurse, Roylyn T., immediately requested a joint WOCN visit. The goal was to manage the fistulas and allow Marlene to remain safely at home until she could have further corrective surgery. During that visit Mary worked with Roylyn to devise a system for containing the leakage using an approach called pouching.

“Marlene now only requires management twice a week to remove the old pouch and apply a new one,” says Mary. Although that changeover process is still demanding—it can take up to several hours to complete—it is allowing Marlene to enjoy a good quality of life at home with her family until her next surgery is scheduled.

Mary’s commitment to supporting home care nurses is a hallmark of the WOCN team. “These cases can be incredibly challenging,” says Mary, who has been with VNSNY for 16 years. “The work our home care nurses do caring for these patients is absolutely heroic.

“Having a problematic wound or ostomy issue is a life-changing crisis,” says Mary. “It’s a very intimate thing our frontline nurses are doing, providing hands-on care for these patients. I’m proud to help support them.”

* The patient’s name has been changed for privacy.

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