Presentation on theme: "Ventricular Assist Device Exit Site Care"— Presentation transcript:
1Ventricular Assist Device Exit Site Care Nicole Graney, MSN, CNS-BC VAD CoordinatorAdvocate Christ Medical Center
2Ventricular Assist Device Percutaneous Lead Referred to also as:DrivelinePerc LeadThis 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.
3Percutaneous LeadThe 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.
4Exit SiteThe exit site is the location where the percutaneous lead goes out through the skin
5Caring 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.
6Assessment of Exit Site Tissue in-growthDrainageSurrounding Tissue
7Assessment 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.
8Tissue In-growthRefers 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 velourCan be describe in percentagesAnywhere from 0 to 100 %Problem: Percentages may differ between person assessingCan be described as Partial or CompleteCan 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
10DrainageImportant to NoteAmountColorOdorConsistency
11Note any erythema, edema, blisters, hypergranulation tissue etc. Surrounding TissueAppearance of surrounding tissue may indicate presence of early infection, even without drainage or fever.Note any erythema, edema, blisters, hypergranulation tissue etc.
12InfectionInfection 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.
13Risk 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.
14Signs of Symptoms of Infection Localized Exit Site:Redness, warmth, tendernessWith or without positive culturesNew or increased drainageSevere Exit Site Infections or Pocket Infections:Fever, Elevated White Blood Cell CountPurulent drainagePain at exit site or over devicePositive wound culturesFluid surrounding perc lead up to the devicePatient may become septic as a resultFluid over device, erythema over pocket
16Treatment LocalizedIncrease frequency of driveline dressing changes if drainage presentImmobilize perc leadStart antibiotics if culture positiveMonitor frequently as outpatientInitiate aggressive wound care modalities: silver impregnated dressings, ultrasound mist therapy.
17Progression of Infection Severe Exit Site/Pocket Infection
18Treatment Severe Exit or Pocket Infections HospitalizationIV antibioticsAggressive Wound Care ModalitiesSurgical Drainage of fluid collection