Can I reinfuse two or more stomas or fistulas?

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Yes, you can but please consider the following:

  • The output that is being reinfused must be chyme, originating from the small bowel so the viscosity will work with The Insides System.
  • What is the goal?
    • For preservation of the out of circuit intestine that will not be resected at the time of reversal?
    • Maximising nutrition?
    • Maximising hydration, or both?
  • Does the patient have the dexterity, enthusiasm, and family/friend support to manage two tubes, and thus two bolus reinfusions?
  • Guidance around manging two (or more) reinfusions systems:
    • Focus should be placed on reinfusing the most proximal distal limb to ensure maximal absorption of nutrients.
    • Introduce the second reinfusion once the patient is confident with the first. This must be a slow methodical titration to ensure the patient is coping.
    • Provide support around ostomy appliance changes until they are independent and confident
    • If the second double barrel/fistula outlet (distal to the first) is located in the distal jejunum/proximal ileum, reinfuse as often as possible into this distal limb as well.
    • If the second double barrel/fistula outlet (distal to the first) is located in the distal ileum/ascending colon, reinfuse chyme into this distal limb as much as clinically indicated to ensure nourished and hydrated (This may mean onl7 2-4 times per day)
    • Once the terminal ileum is back “in circuit”, a patients output will thicken up considerably so ensure the patient knows how to thin their output, wean off anti-motility medication and perhaps reduce reinfusions to twice a day (discarding thick output that cannot be reinfused).
  • Follow up with the patient regularly to ensure they are managing well. Pause reinfusing the second distal outlet if there are concerns around coping and restart once the patient is ready.

Regularly reassess the goals of reinfusion.

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