PURPOSE: Our experience indicates that a proactive bowel management with aid of the Zassi/Hollister Bowel Management System (BMS) represents an economical and clinically advantageous practice for the fecal management of burn patients unable to defecate independently. A question that has been queried often is whether or not patients with bleeding complications could have bleeding diathesis potentially associated with a proactive BMS on insertion and while it remains in place? Based on anecdotal evidence from our larger study population and ongoing data bases, we believed that the incidence would be predictably low (Null Hypothesis).
METHODS: A retrospective analysis of our previous population of patients evaluated with a proactive BMS, all with complicated burns/wounds, were included. Total n=69. Patient records were queried for coagulation and thrombocytopenia abnormalities at BMS insertion and all subsequent events while the apparatus was in place, until removal. If gastrointestinal (GI) complications were documented, they were reviewed extensively for association with the proactive BMS.
RESULTS: 69 patients, 48 males, 21 females, mean age 50.8 years (range 19–87), mean TBSA of 30.5% (range 0–80) and mean length of stay of 47.5 days (7–208) were evaluated. Thrombocytopenia was documented at insertion or while the BMS was in place a mean of 10.7d (range 0–46d). Prothrombin (PT), Partial Thromboplastin (PTT) and/or Fibrinogen was abnormal during insertion or while the BMS was dwelling for a mean of 13.7d (range 0–113). 63 patients (92.7%) at high risk for bleeding problems did not experience any bleeding or GI complications. Five patients (7.3%) had documented GI abnormalities; however, only one (1.4%) could be directly related to the BMS but had rapid resolution.
CONCLUSION: The current findings reveal that placement of this proactive BMS in complicated ICU patients is safe, even in the setting of continued risks of bleeding due to coagulation and/or thrombocytopenia abnormalities.
CLINICAL IMPLICATIONS: Future research should include these and other groups of patients in multicenter evaluations, to hopefully improve the already monumental task of nursing care for burns and other critically ill patients.
DISCLOSURE: Bruce Friedman, Consultant fee, speaker bureau, advisory committee, etc. The presenting author is an active member of the speakers’ bureau for Hollister.; No Product/Research Disclosure Information