Variability in Infection Control Measures for the Percutaneous Lead among Programs Implanting Long-Term Ventricular Assist Devices in the United States

Abstract

Ventricular assist devices (VADs) are a surgical treatment for heart failure. These devices may be implanted as a bridge to transplant or as destination therapy. After surgical recovery and education regarding device care, patients are discharged home. Meticulous care of the driveline must be taken to prevent infection and trauma of the site throughout the perioperative event and for the duration of support. Currently a standardized protocol for care of the driveline and exit site does not exist. VAD coordinators from across the country discussed the variability in care at different centers in the United States through a series of conference calls. A survey consisting of 16 questions was developed. The survey included questions on preoperative antibiotic recommendations, driveline placement and exit site suturing, frequency of dressing changes, and showering practices. VAD coordinators shared center-specific dressing protocols and any driveline success stories. This survey was sent to 73 centers; 38 centers (52%) responded. The purpose of the survey was to define current practice in order to move toward a standard of practice or protocol based on expert opinion for VAD driveline care and to assess the need for future studies.

Decrease in Driveline Infections With Change in Driveline Management Protocol

“…Despite all these issues and the fact that over 15,000 VADS have been implanted worldwide, (15) there is no consensus on the optimal driveline management protocol, as evidenced by a recent US survey of VAD centers. (7) Driveline management consists of driveline stabilization as well as the exit site cleansing and dressing. In this study, we demonstrated a significant decrease in DLI in our VAD population by a change in driveline management strategy.…”

“…(7) Several recent papers discuss alternative stabilization techniques for the driveline such as use of StatLock system with a silicone suture, Centurion Foley anchor, or Hollister tube holder instead of the abdominal binder that is easier and more comfortable for the patient to use. (7,8) The same survey also noted that there was no standard for dressing change protocols in terms of agents used and the frequency of dressing changes though 60% of programs reported daily dressing changes. It is also not clear if sterile technique should be applied at each dressing change.…”

Quality Over Quantity: Standardization of Pediatric HeartWare Ventricular Assist Device Dressing Changes

“…7 Selection of products is based on prior experience or clinical preference with minimal guidance in the literature in terms of standardization. 8 Individualization results in variability in care in both the inpatient and outpatient setting, which can have a negative impact on patient compliance and increase the chances for infection. 5…”

“…Despite efforts to provide education regarding dressing change procedures and supplies as part of the discharge process, 9 standardized techniques for dressing changes among VAD centers do not exist in the United States. 8 Survey results on outpatient management of adult patients with a continuous-flow VAD report a frequency in dressing changes ranging from once daily to once weekly. 10 Dressing change kits help to standardize and simplify driveline site management while providing added stability, promoting comfort, and decreasing the risk of infection.…”

Dispositivos De Assistência Ventricular E Cuidados De Enfermagem

“…From this study, it was possible to define a standard practice protocol based on the opinion of VAD specialists for general care of the equipment and patients. 25 Another complication associated with the use of this device is the occurrence of bleeding, which is caused by several factors such as coagulation disorders and hepatic dysfunction. 37 In addition, we can highlight complications including DNA damage and oxidative stress; 30 lower carotid artery complacency and distensibility, which can lead to pressure on the left ventricle; 29 multiple organ failure; neurological events 9 (long-term embolic or hemorrhagic events can occur); renal failure; 39 mechanical dysfunction; and psychological changes.…”