Mechanical Circulatory Support to Manage Heart Failure
Heart failure is a significant cause of morbidity and mortality that affects approximately 26 million patients worldwide, with rates continuing to climb.¹ Mechanical circulatory support (MCS) is an intervention to manage heart failure, often serving as bridge to transplantation (BTT) by providing acceptable quality of life for patients awaiting organs.¹²’ MCS use has grown significantly because demand for organs greatly outpaces supply.¹
Left ventricular assist devices (LVADs) are a type of MCS that have revolutionized treatment of advanced heart failure. With these devices both improving survival rates and allowing patients to be mobile, rates of
LVAD implantation continue to rise annually.³ Patients can await transplantation at home, able to perform routine activities as long as proper maintenance guidelines and precautions are followed.⁴
MCS Complications: Driveline Infection
Drive Line infection (DLI) is one of the most common LVAD complications, reported to occur in between 14‐48% of patients.⁵ These infections develop because the driveline exit site can serve as the portal of entry
for pathogens.⁶ Thus, driveline exit site protection is critical. However, there is no gold standard method for driveline exit site care, as research on this area is limited.²
Driveline infection can result in hospitalization, reoperation, increased risk of stroke and delay in transplantation.³
Most DLIs occur late after placement (>30 days), which is often after the patient is discharged from the hospital. Patients who experience longer support time and have a history of trauma to the area may be more susceptible to these infections.³’⁶
Guidelines to Prevent LVAD‐Associated Infection
Since many patients are able to return home after LVAD implantation, it is essential for clinicians to educate patients and caregivers about proper site and device maintenance. The patient/caregivers’ ability to practice
proper site care is a large factor in preventing and identifying DLIs.
While there are currently no standard guidelines for infection control and prevention in MCS device recipients,⁶ the following recommendations serve to lower overall infection risk as patients and caregivers navigate LVAD maintenance and site care at home.
Redness, swelling, drainage around exit site, pain, or fever are signs of possible infection. Patients should notify their LVAD team immediately if they experience any of these symptoms.⁴
Device Maintenance and Dressing Changes
Proper LVAD site care is essential to prevent the development of DLIs. In the absence of standard guidelines, it is important to follow your institution’s protocols when it comes to preventing infection and other complications during device maintenance and dressing changes.
Skin damage may occur during repeated application and removal of dressings and medical devices, including LVADs. Using Detachol® Adhesive Remover allows for gentle removal. It can reduce risk of skintear injury while removing dressing and adhesive residue. Detachol’s alcohol/acetone‐free formulation is non‐irritating to the skin and compatible with chlorohexidine gluconate (CHG).⁷’⁸’⁹’¹⁰
Maintaining dressing integrity between scheduled changes is an important part of preventing infection. The lasting power of Mastisol® Liquid Adhesive helps reduce the likelihood of dressing displacement thereby
minimizing infection risk by creating a lasting occlusive dressing barrier.¹¹’¹²
Eloquest Healthcare is committed to providing solutions that can help increase dressing/device adherence and facilitate dressing/device removal. For more information about Detachol and Mastisol, please send us a message or fill out this form.
References
1. Bowen RES, Graetz TJ, Emmert DA, Avidan MS. Statistics of heart failure and mechanical circulatory support in 2020. Ann Transl Med. 2020;8(13):827.
2. Ozdemir Z, Celik SS. Wound care of the driveline exit site in patients with a ventricular assist device: A systematic review. Turk J Thorac Cardiovasc Surg. 2018;26(2):328‐335.
3. Yarboro LT, et al. Techniques for minimizing and treating driveline infections. Ann Cardiothroac Surg. 2014;3(6):557‐562.
4. MyLVAD. www.mylvad.com/patients‐caregivers/lvad‐lifestyle/livinglvad/ driveline‐management. Accessed July 27, 2021.
5. Leuck AM. Left ventricular assist device driveline infections: recent advances and future goals. J Thorac Dis. 2015;7(12):2151‐2157.
6. Kusne S, Staley L, Arabia F. Prevention and Infection Management in Mechanical Circulatory Support Device Recipients.Clin Infect Dis. 2017:64(2):222‐228.
7. McNichol L, Lund C, Rosen T, et al. Medical adhesives and patient safety: state of the science. Consensus statements for the assessment, prevention, and treatment of adhesive‐related skin injuries. J Wound Ostomy Continence Nurs. 2013;50:365‐80.
8. Berkowitz DM, Lee W‐S, Pazin GJ, et al. Adhesive tape: potential source of nosocomial bacteria. Appl Microbiol. 1974;28:651‐54.
9. Redelmeier DA, Livesley NJ. Adhesive tape and intravascular‐catheterassociated‐infections. J Gen Intern Med. 1999;14:373‐5.
10. Ryder M, Duley C. Evaulation of compatibility of a gum mastic liquid adhesive and liquid adhesive remover with an alcoholic chlorohexidine gluconate skin preparation. J Infus Nurs. 2017;40(4):245‐52.
11. Lesesne CB. The postoperative use of wound adhesives: gum mastic versus benzoin, USP. J Dermatol Surg Onc.1992;18(11):990.
12. Timsit J. et al. Dressing disruption is a major risk factor for catheter related infections. Crit Care Med. 2012;40(6)1701‐1714.
