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1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection.

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Presentation on theme: "1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection."— Presentation transcript:

1 1 EXCOR ® Wound Care

2 EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection  Perform wound care by a trained group  Intensively instruct patient and relatives in case of out of hospital option

3 EXCOR ® Wound care : Intervals Primary wound healing  POD 1-3 Control wound dressing every day  Change wound dressing depending on used products and the level of bleeding  > POD 3 Change wound dressing every two days  > POD 20 Change wound dressing twice a week Secondary healing / Signs of infection  Clean wound and change dressing twice a day  Leave a dressing on for a number of days depending on used products and the level of exudate

4 EXCOR ® Wound care : Preparation  Sterile working area  Disinfectant (e.g. Octenisept ® ; Chlorhexidine)  Wound Irrigation Solution with Polyhexanide (PHMB; e.g.Prontosan ® )  Sterile plaster and adhesive dressing (e.g. 7x5cm and 10x15cm)  Sterile gauze compresses and drain compresses  Protective clothes  Sterile gloves  Operation mask  Operation gown  Cap

5 INCOR ® Wound care : Removal old dressing  Prepare all materials on a sterile drape  Wear sterile gloves, cap, mask, and gown  Remove old dressing  Avoid damage of cannulae, especially if you handle with sharp instruments  Change sterile gloves  Assess wound and take appropriate measures if necessary  Take digital pictures if possible to document changes  Take specimen for culture and sensitivity if signs/symptoms of infection

6 EXCOR ® Wound care : Removal old dressing  Clean exit area of the exit sites with sterile gauze compress, tinctured with disinfectant (Octenisept ® / Chlorhexidine 0,2%)  Clean EXCOR ® Velours with hydrogen peroxide (H 2 O 2 )  Clean skin also with sterile gauze compress, tinctured with disinfectant Start at the cannula and move outwards  Wound Irrigation with Polyhexanide Solution (PHMB; e.g.Prontosan ® )

7 EXCOR ® Wound care : New Dressing  Drainage pad around driveline - slot position to the head  Fix the compress with a plaster  Nothing sticky directly on cannula velour Effect  Cover the exit site

8 EXCOR ® Wound care : New Dressing  Position a longitudinal folded compress around each cannula  Open side pointing upwards Effect  Cover the exit site  Strain relief

9 EXCOR ® Wound care : New Dressing  Cushion underneath cannulae  Fix compress with sterile bandage Effect  Prophylaxis of decubitus

10 EXCOR ® Wound care : New Dressing  Cover with sterile compress Effect  Proper fixing  Reduce risk of infection

11 EXCOR ® Wound care : New Dressing  Cover completely with adhesive dressing  Fix dressing on right and left side under cannulae and between cannulae Effect  Proper fixing  Reduce risk of infection

12 12 EXCOR ® Advanced Wound Treatment

13 EXCOR ® Wound care : Prevention of infection  Optimization of preoperative skin antisepsis  Standard aseptic sterile technique for implantation  Protection of contamination for the VAD components  Minimized traffic in OR  Optimization of surgical hand disinfection  Fast implantation  Secure hemostasis  Minimal tissue trauma  Standard aseptic sterile technique for wound dressing change  Surgical hand disinfection for wound dressing change  Immobilization of cannulae

14 EXCOR ® Wound care : Complications in healing  Exit site is too small or too large  Patient loses or gains weight  Additional risk factors (e.g.: diabetes, cachexia)

15 EXCOR ® Wound care : Complications following infection  Sepsis  Mediastinitis  Peritonitis  Multi organ failure

16 EXCOR ® Wound care : Signs of infection  Increased or sustained pain  Redness  Swelling  Pus discharge

17 4 Skin pulled away from driveline Large amount of drainage Large amount of redness Painful 3 Skin pulled away from driveline Drainage increasing Redness increasing Tenderness 2 Initial tear or trauma to exit site Drainage - note amount, color, odor Slight redness Slight tenderness 1 Skin is incorporated to the driveline No drainage Little or no redness No tenderness EXCOR ® Wound care : Exit site scale Utah Artificial Heart Program / Intermountain Helthcare

18 Wound care UTAH Scale 2 Drainage Redness Swab / Blood culture / Antibiogram AB treatment according to antibiogram Wound Irrigation with vancomycine (morning) hypersaline solution (evening) Wound dressing aluminized top layer of dressing (e.g. Metalline ® ) Wound dressing with properties of hydrophobic interaction (e.g. Cutimed Sorbact ® ) Antimicrobial Wound Dressing with PHMB (e.g. Suprasorb ® X + PHMB) Documentation

19 Wound care UTAH Scale 3 Infection with exsudate Swab / Blood culture / Antibiogram AB treatment according to antibiogram Wound Irrigation with vancomycine (morning) hypersaline solution (evening) Wound dressing aluminized top layer of dressing (e.g. Metalline ® ) Wound dressing with properties of hydrophobic interaction (e.g. Cutimed Sorbact ® ) Antimicrobial Calcium Alginate Dressing (e.g. Suprasorb ® A) Documentation

20 Wound care Wound pocket near exit site Wound dressing aluminized top layer of dressing (e.g. Metalline ® ) Hyaluronic acid micro-granular compound (e.g. Hyalogran®) or Wound Irrigation with vancomycine (morning) hypersaline solution (evening) Documentation

21 Wound care Deep wound defectWide excision, drainage, and debridement of infected driveline tract Vacuum-assisted closure system (e.g. KCI V.A.C., Hartmann Vivano) Documentation

22 EXCOR ® Wound care With kind permission of F. Müller, ICU, Universitätsklinikum Heidelberg, Germany

23 Frequently asked questions QDo I need to change the dressing frequently to check the wound ? A It is advisable to leave a dressing on for a number of days depending on used products and the levels of exudate. Examine the dressing carefully. It can be left in place if there is no sign that the dressing is going to leak out. With some dressings you can see the exudates on the back of the dressing. Remember ‘a bad cook often opens the oven door’. Q Does the dressing heal the wound? A No, the dressing simply provides the optimum environment for healing to take place. For example, it removes dead tissue, provides a warm, moist environment and reduces the number of bacteria in the wound. QDo some wounds require three or more dressings at one time together? A It is unusual for a wound to need more than two dressings. Try and avoid using any more than two dressings at one time.

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