Transcript Ventricular Assist Device Exit Site Care

Ventricular Assist Device
Exit Site Care
Nicole Graney, MSN, CNS-BC
VAD Coordinator
Advocate Christ Medical Center
Ventricular Assist Device
Percutaneous Lead
Referred to also as:
Driveline
Perc Lead
This lead connects the
implanted device to the
external controller which
provides power to the
pump and controls
operation.
Thoratec Corporation. HeartMate II Patient
Handbook, 2008.
Percutaneous Lead
The outside of the lead is covered with a special
material (velour) that allows skin cells grow into it.
A well-healed exit site can lower the risk of infection.
Exit Site
The exit site is the location
where the
percutaneous lead
goes out through the
skin
Caring for the Perc Lead Exit Site







Keep the exit site clean, dry and covered.
Ensure patient and caregiver performing proper hand
washing and “aseptic technique” when changing bandage
or handling the exit site.
Keep perc lead stabilized using Stabilization Belt.
Protect the system controller from falling or from pulling on the
lead.
Don’t allow the perc lead to catch or snag on anything that
will pull or move the lead.
Check lead daily for signs of damage.
Report any concerns of damage or infection to patient’s VAD
Coordinator.
Assessment of Exit Site



Tissue in-growth
Drainage
Surrounding Tissue
Assessment of Exit Site



Most VAD infections began at the
perc lead exit site.
Accurate assessments allow the health
care provider to identify and promptly
treat driveline infections.
If any concerns, please contact
patient’s VAD coordinator.
Tissue In-growth


Refers to amount of tissue growing into the perc
lead.
If complete in-growth, should not be able to retract
back on abdomen and expose any velour

Can be describe in percentages



Anywhere from 0 to 100 %
Problem: Percentages may differ between person assessing
Can be described as Partial or Complete

Can specify where tissue in-growth is using hours on a clock
using circumference of driveline as the clock.

Complete in-growth from 2-6 o’clock position
Tissue In-growth
100 % Tissue In-growth
Or
Complete Tissue
In-growth
Drainage

Important to Note




Amount
Color
Odor
Consistency
Surrounding Tissue
Appearance of
surrounding tissue
may indicate
presence of early
infection, even
without drainage or
fever.
Note any erythema, edema,
blisters, hypergranulation
tissue etc.
Infection



Infection is one of the common causes
of mortality in patient’s with VADs.
The treatment of VAD related
infections negatively impacts patient’s
quality of life and length of survival
with VAD.
Prevention of infection is one of the
primary goals of patient management.
Risk for Infections



Patients are at an increased risk for
infection.
Chronic HF, poor nutrition, advanced age,
other co-morbidities (DM, COPD etc.).
Presence of foreign body (VAD and perc
lead), trauma to exit site, tension to wound
edges, poor dressing care technique.
Signs of Symptoms of Infection

Localized Exit Site:




Redness, warmth, tenderness
With or without positive cultures
New or increased drainage
Severe Exit Site Infections or Pocket Infections:







Fever, Elevated White Blood Cell Count
Purulent drainage
Pain at exit site or over device
Positive wound cultures
Fluid surrounding perc lead up to the device
Patient may become septic as a result
Fluid over device, erythema over pocket
Progression of Infection
Localized
Treatment
Localized





Increase frequency of driveline
dressing changes if drainage present
Immobilize perc lead
Start antibiotics if culture positive
Monitor frequently as outpatient
Initiate aggressive wound care
modalities: silver impregnated
dressings, ultrasound mist therapy.
Progression of Infection
Severe Exit Site/Pocket Infection
Treatment
Severe Exit or Pocket Infections




Hospitalization
IV antibiotics
Aggressive Wound Care Modalities
Surgical Drainage of fluid collection
Device Infection/Sepsis
Treatment
Device Infection/Sepsis



Surgical implantation of antibiotic
beds
Expose device to allow for constant
drainage
Device Exchange as last resort
Complications of
Persistent Exit Site Infections




Sepsis
Exposure of device
Stroke
Death
Trauma

Trauma to perc lead either due to
pulling, tearing, or dropping of
equipment may lead to infection,
damage of equipment, or pump
stoppage.
Perc Lead Fracture


If complete severing of electrical
leads, the pump will STOP!
Patients may not survive pump
stoppage, or may go into cardiogenic
shock
Perc Lead Fracture
Perc Lead Fracture
Questions???