PURPOSE: 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. One question that has been queried often is, “What are the long-term continence complications potentially associated with a BMS having been in the rectum for at least 30 days?” Based on anecdotal evidence from routine clinic follow-up, we believed that the incidence would be predictably low. (Null Hypothesis).
METHODS: We undertook a prospective observational phone survey of complicated burn patients who had a BMS in place for 30 days or greater and had been discharged from the hospital for at least six months. Total n=59. Patients were contacted by phone and asked a series of eight questions centered around their BMS experience and any possible current complications with specific reference to continence issues.
RESULTS: Twenty patients, 16 males and 4 females, mean age 38.8 years (range 21–62), with a mean TBSA of 44% (range 13–87) and a mean length of stay of 69.5 days (range 30–210) were queried and their data evaluated. 70% (14/20) did not remember having the BMS placed, 30% (6/20) did. No patient described discomfort while the BMS was in place, however, 30% (6/20) noted significant initial pain on removal. One patient noted constipation at time and two patients had occasional, but controllable diarrhea. All patients surveyed remained continent of stool for six months or greater post BMS removal.
CONCLUSION: The Zassi/Hollister proactive bowel management system has been proven to be cost-effective and provide overall reduction in infectious complications and breakdown in complicated burns. The current findings reveal that long-term placement of this device does not cause incontinence or any significant complications.
CLINICAL IMPLICATIONS: The BMS remains a safe, efficacious tool that provides integrity to patients and their families, and improves the already monumental task of nursing care for complex burns.
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