Preventing Infection - Proper Care for VAD Drivelines

Publication Date: 
Mon, 07/25/2016
By: Alere Staff

Ventricular Assist Device (VAD) implantation is a lifesaving surgery for many patients classified in end-stage heart failure. The improved circulation of blood that the patient will experience post implant may enable them to return to daily life with minimal restrictions. However, since an implanted VAD device is connected to its power source from a cable that comes from the heart to outside the body, these patients are at high risk for infection since as there is no barrier from end to end. Proper driveline management is imperative for preventing infection. Prevention of infection is an ongoing concern for these patients throughout the duration of their time living with their VAD. 

According to an analysis of the Interagency Registry for Mechanical Assisted Circulatory Support (INTERMACS) database, nearly 50% of patients receiving a left ventricular assist device (LVAD) experience a hospital readmission within six months of implantation.1 Most first-time readmissions are for infection and bleeding.1 Infection is first in a list of ten main reasons for readmission amongst LVAD patients.1 With all this being noted, one can see the importance in staying infection free. 

Preventing Infection

There are several key things you should always do to prevent infection of a VAD driveline. First and foremost is the practice of hand washing. Hand washing can help prevent all sorts of infections. Keeping hands clean is one of the most important steps you can take to avoid getting sick and from spreading germs to others.2 VAD patients are constantly reminded to wash their hands and to encourage those around them to do the same. 

VAD patients must also properly care for their exit site. The exit site is where the driveline, a tube encased around wires, exits the body. The driveline connects directly into the heart and then exits the body through the abdomen. It then attaches externally to the VAD system controller, what could be considered the brain of the device which regulates the functions of the VAD.  Maintaining the exit site means keeping it infection free and the skin intact. 

Sterile dressing changes are imperative. Patients and caregivers receive instructions about proper technique in a variety of ways. Initially, they observe a nurse changing the dressing at the driveline exit site on the patient's abdomen. They are given a manual that has step-by-step instructions as well as sterile gloves and supplies so they can practice the technique. The second step is to participate in a dressing change. The final step is for them to perform a dressing change by themselves with supervision.3 VAD patients must adhere to the “sterile technique” for the duration of their time living with a VAD, which can often mean daily dressing changes. 

Another way to minimize infection at the driveline exit site is by properly immobilizing/stabilizing the driveline. This is achieved by using a securing device for attachment to the skin. There are several types available and prescribed to patients. These will ensure the area will stay intact. Snagging of the driveline can lead to skin tears. Torn skin is open and vulnerable to bacteria, placing the patient at increased risk for infection. Covering the driveline with a large sterile barrier over the sterile dressing /exit site helps to keep the driveline secure and prevents it from snagging, minimizing the potential for trauma at the site. 

Diligence to prevent infection is necessary in this high-risk population. These patients are monitored frequently by their hospital team and are encouraged to promote great hygiene by washing their hands frequently. Ultimately, remaining infection free will decrease this patient populations’ risk of hospital readmission. 

References:

  1. International Society for Heart and Lung Transplantation (ISHLT) 31st Annual Meeting and Scientific Sessions. Readmission Rates with LVADs Nearly 50% at 6 Months. Medscape Medical News. April 19, 2011. Retrieved from the website: http://www.medscape.com/viewarticle/790886.
  2. Centers for Disease Control and Prevention, NCEZID, DFWED. Keeping Hands Clean. CDC.gov. February 1, 2011. Retrieved from the website: http://www.cdc.gov/healthywater/hygiene/hand/handwashing.html.
  3. Bond, A. E., DNSc, APRN, CCRN, et al. Nursing Education and Implications for Left Ventricular Assist Device Destination Therapy. Progress in Cardiovascular Nursing. 2004; 19(3). Retrieved from the webstie: http://www.medscape.com/viewarticle/483576_2.