1. Ventricular Assist Device Exit Site Care
Nicole Graney, MSN, CNS-BC VAD Coordinator
Advocate Christ Medical Center

2. 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.

3. 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.

4. Exit Site
The exit site is the location where the percutaneous lead goes out through the skin

5. 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.

6. Assessment of Exit Site
Tissue in-growth
Drainage
Surrounding Tissue

7. 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.

8. 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

9. Tissue In-growth
100 % Tissue In-growth Or
Complete Tissue
In-growth

10. Drainage
Important to Note
Amount
Color
Odor
Consistency

11. Note any erythema, edema, blisters, hypergranulation tissue etc.
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.

12. 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.

13. 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.

14. 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

15. Progression of Infection Localized

16. 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.

17. Progression of Infection Severe Exit Site/Pocket Infection

18. Treatment Severe Exit or Pocket Infections
Hospitalization
IV antibiotics
Aggressive Wound Care Modalities
Surgical Drainage of fluid collection

19. Device Infection/Sepsis

20. Treatment Device Infection/Sepsis
Surgical implantation of antibiotic beds
Expose device to allow for constant drainage
Device Exchange as last resort

21. Complications of Persistent Exit Site Infections
Sepsis
Exposure of device
Stroke
Death

22. Trauma
Trauma to perc lead either due to pulling, tearing, or dropping of equipment may lead to infection, damage of equipment, or pump stoppage.

23. 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

24. Perc Lead Fracture

25. Perc Lead Fracture

26. Questions???