"I had minimal experience with manual chyme reinfusion prior to working with The Insides Company but was familiar with the therapy and its benefits. However, I very quickly saw the major benefits of automating the therapy to help patients own their journey and get home quicker." - Emma Ludlow, Lead Stomal Therapist at The Insides® Company.
The easiest way I have found to explain the device to a patient and what it is going to do for them is to start with what the small intestine’s role is in the digestive system. I then follow through with a diagram of their own digestive system and where their stoma/fistula is. I then use the demonstration kit to show how The Insides® System works and will work with them. I have further conversation around what their current clinical interventions are and how this will impact and reduce some interventions like PN and IVS. I also provide the information sheet from The Insides Company.
There are testimonials on the company’s website from patients across the world. There is also opportunity to talk to past patients who have offered their services to speak with new patients starting out.
Once the patient is medically cleared to start, I take them through why digital palpation of the ostomy is needed and what it will most likely feel like. They’re then able to translate this to how it is going to feel having the Tube inserted. I will talk them through the procedure of Tube insertion, device set-up and then how I will support them through learning the device and increasing tolerance to chyme reinfusion over the next week.
There is an upfront time commitment to set up the patient, but it is repaid very quickly as a result of the reduction/removal of medication administration time for PN. This upfront time is spent on;
- Explaining and gaining patient consent - around 15-30 minutes
- Device set-up and troubleshooting - around 1 hour
- The first week support - If the patient is an inpatient with an enterostomy this would be approximately 10-15 min per day but decreasing over the week. If the patient has an EAF this would likely need to include wound and ostomy care so closer to 20-30 minutes per day.
Once the patient is established and independent with the system there is little nursing task input outside the monthly Tube change which is approximately 10 minutes. This does not factor in chasing blood results and non-patient facing support.
By the end of the second week, most patients express that they are feeling comfortable with the System and changing their ostomy appliances.
What they have found most difficult is the pouch changes and coordinating their hands better to keep the Tube still while removing the pouch. This takes some practice but if they are slow and methodical they are generally able to work out a routine for themselves within a couple of weeks.
Placing a new ostomy pouch is easier if the template aperture is 35mm or wider and they use a seal to protect the exposed peri-stomal skin. Splitting the hydroid seal and “winding’ around the stoma is easiest.
Most patients agree a 2-piece ostomy appliance is easier to manage due to being able to decouple the pouch, remove the old Pump and then remove the base plate. However, if the template of the appliance is wider than 40mm, it is much the same.
Seeing patients taking charge of their own health journey and being able to go home to be with their families.
That sense of accomplishment on their faces when they become comfortable with the System.
Seeing the reduction of clinical interventions such as IVF and PN which allows patients the opportunity to go on extended hospital leave or walking out the door on discharge.