Driveline exit-site care protocols in patients with left ventricular assist devices: a systematic review

Abstract

OBJECTIVES Driveline infections continue to be a significant complication following left ventricular assist device (LVAD) implantation. Driveline exit-site care is crucial for the prevention of infections; however, there are no uniform guidelines. The goal of this study was to provide an overview of the currently published driveline exit-site care protocols in patients with LVAD. METHODS A systematic literature review was performed. Studies before 15 December 2020 were included if the number of driveline infections was a primary outcome and the driveline exit-site care protocol was explained. RESULTS Eleven articles were included in the systematic review, including 1602 patients with LVADs. The median of the frequency of driveline infections in the articles was 13.8% with a range of 0–52.6%. There was a marked variability in the methods of care of driveline exit sites, without a standardized driveline dressing technique in patients with LVADs. The frequency of driveline infections was 6–7.5% in studies using a dressing kit that included chlorhexidine, a silver-based dressing and an anchoring device. Furthermore, there was variability in the anchoring devices and the frequency of dressing changes, which varied from daily to weekly. No specific anchoring device or change frequency was found to be superior. CONCLUSIONS Based on this systematic review, driveline exit care protocols that included chlorhexidine, a silver-based dressing, the use of an anchoring device and dressing kits might be best in reducing driveline infection rates. However, prospective studies with larger cohorts are needed to establish the optimal protocol for driveline exit-site care.

Ten‐year retrospective cohort analysis of ventricular assist device infections

“…Our infection prevention strategy uses a relatively standard protocol when compared to the protocol of other institutions and our infection rate is comparable to prospective studies on the subject (0%–52%) 16 …”

“…Our infection prevention strategy uses a relatively standard protocol when compared to the protocol of other institutions and our infection rate is comparable to prospective studies on the subject (0%-52%). 16 This study did not identify any risk factors predicting the incidence of VAD-specific/related infection in VAD patients. In this topic evidence in the published literature is conflicting.…”

Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients

“…Different adhesive anchoring devices are used to secure the LVAD DL to provide stability and minimize tension on the DLES. 8,11,12,14 The selection of an appropriate anchoring device plays a critical role in reducing DLI, as trauma to the DLES caused by movement and manipulation of the DL during everyday activities is a major risk factor for DLI. 9,30 This study, which provided evidence based on in vitro tensile force measurement, supports the clinical recommendations 8,14 for the use of an anchoring device by clearly demonstrating that each of the eight anchoring devices tested provides some protection against tensile forces compared to no anchoring device (Figure 3).…”

“…7,10,11 To date, there is little evidence as to which dressing technique is most effective, and no consensus on a best practice dressing procedure has been established. 11,12 This lack of best practice is reflected in the wide variability in DL infection rates between VAD centers. 13 The most beneficial care protocols appear to be those that include chlorhexidine, a silver-based dressing, and an adhesive anchoring device to immobilize the DL.…”

Pseudomonas aeruginosa left ventricular assist device (LVAD) driveline infection acquired from the bathroom at home

“…Current focus is on (peri-operative) wound care, without specific measures to protect patients at home. 6 Preventing infection with waterborne pathogens should include control of shower water quality. Point of care filters might contribute to this, but are costly and can be difficult to install and use correctly.…”