Heart failure is a growing public health issue, and for those with advanced or end-stage heart failure, left ventricular assist devices (LVADs) are a true technological lifeline. Alongside heart transplants, LVADs have become the standard of care for patients with advanced heart failure, serving as a bridge to transplant, a bridge to recovery, or more often today, destination therapy.
LVADs consist of an electronic pump implanted in the abdomen with an external power source connected by a tunneled subcutaneous driveline (DL). Maintaining DL dressings for LVADs can be challenging for clinicians and patients/caregivers alike. The DL exit site, which is typically in the abdominal wall, is a point of entry for pathogens. To reduce the risk of infection, patients/caregivers must perform routine sterile dressing changes, typically once the dressing is compromised (i.e., the edges of the dressing are lifted or there is partial detachment from the skin).
Rates of infection are the highest within the first year after LVAD implantation, with most events occurring after discharge from the hospital.1 Infection control is a priority for patients with LVADs particularly because these individuals are more likely to be colonized with multidrug resistant bacteria.2 To make matters worse, more frequent dressing changes are associated with higher rates of potentially life-threatening infections.3
Historically, infection control efforts have been thwarted by variability in driveline dressing care and the complexity of daily at-home management by patients/caregivers. With LVAD use expected to skyrocket due, in part, to the aging Baby Boomer population and the rising incidence of obesity and diabetes, researchers are redoubling their efforts to reduce DL infection rates.
Using gum mastic liquid adhesive (Mastisol® Liquid Adhesive) to extend the life of DL dressings appears to be a viable solution for patients with LVADs, according to a recent study at Dignity Health Mercy General Hospital. Lead study author Abigail Vowels, RN, BSN, Circulatory Device Program Leader at Mercy General Hospital explains, “We found that use of the [gum mastic] liquid adhesive to make the exit site dressings last longer both protects patients from the risk of infection and reduces the amount of time they spend changing their dressings. While it may seem small, this allows them to maintain a more active lifestyle and can have a huge impact on their overall quality of life.” Vowels also reported that fewer dressing changes resulted in an extrapolated cost savings of nearly $600 USD per patient annually!
The benefits of gum mastic adhesive on dressing integrity have been reported elsewhere, including use with vascular access device dressings. In addition, Standard 42 of the Infusion Therapy Standards of Practice recommends incorporating gum mastic liquid adhesive plus liquid adhesive remover for areas like DL exit sites that would benefit from enhanced adhesive adherence.4 By incorporating evidence-based guidelines for vascular access device site dressings, Vowels and her team were able to meet the study objective of increasing dressing durability to 7 days and reducing risk of infection.
Proper DL site dressing techniques are equally as important as extending the life of the dressing. Unfortunately, many patients/caregivers are overwhelmed by fears of infection and the challenge of performing daily at-home dressing care. Study investigators were able to address these barriers by training patients and caregivers to properly remove dressings using a bundled procedure that included the Mastisol Liquid Adhesive plus liquid adhesive remover (Detachol® Adhesive Remover). These interventions effectively reduced the amount of time spent on dressing changes, thereby enhancing patient satisfaction. Study participants agreed that training helped to alleviate the constant worry about performing the dressing change correctly and the risk of infection.
“The adhesive has made my life wonderfully easier because I spend less time worrying about infections or changing my dressings,” said study participant Clayton Elderts, a 72-year-old Rio Vista resident who received an LVAD implant in November 2020. “It’s easy to use and creates an airtight seal, which provides extra protection against contamination and makes the dressing last longer. It works better than anything else I’ve used to keep my dressings intact.”
“LVADs have revolutionized the treatment of advanced heart failure, but they are also complicated and carry a substantial risk of infection,” said Vowels. Based on the study findings, CommonSpirit Health plans to pilot these interventions in LVAD programs throughout the network. Given the lack of established guidelines for DL exit site care, investigators are hopeful that the positive results from the study will lead to a wider adoption of gum mastic adhesive to address the ongoing challenge of reducing DL infections.
Eloquest Healthcare is committed to providing solutions that can both improve patient outcomes and reduce unnecessary costs. For more information about the products evaluated in this study, Mastisol® Liquid Adhesive and Detachol® Adhesive Remover, please call 877-433-7626 or complete this form.
1. Zinoviev R, Lippincott CK, Keller SC, Gilotra NA. In full flow: left ventricular assist device infections in the modern era. Open Forum Infect Dis. 2020;7(5):ofaa124. doi:10.1093/ofid/ofaa124.
2. Donahey EE, Polly DM, Vega JD, et al. Multidrug-Resistant Organism Infections in Patients with Left Ventricular Assist Devices. Tex Heart Inst J. 2015;42(6):522-527. Published 2015 Dec 1. doi:10.14503/THIJ-14-4612.
3. Timsit JF, Bouadma L, Ruckly S, et al. Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med. 2012;40(6):1707-1714. doi:10.1097/CCM.0b013e31824e0d46.
4. Gorski LA, Hadaway L, Hagle ME, et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs. 2021;44(1S Suppl 1):S1-S224. doi:10.1097/NAN.0000000000000396.