ventricular assist device exit site care nicole graney, msn, cns-bc vad coordinator advocate christ...
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Ventricular Assist DeviceVentricular Assist DeviceExit Site CareExit Site Care
Nicole Graney, MSN, CNS-BCNicole Graney, MSN, CNS-BCVAD CoordinatorVAD Coordinator
Advocate Christ Medical CenterAdvocate Christ Medical Center
Ventricular Assist DeviceVentricular Assist DevicePercutaneous LeadPercutaneous Lead
Referred to also as:Referred to also as:
DrivelineDriveline
Perc LeadPerc Lead
This lead connects the This lead connects the implanted device to the implanted device to the external controller which external controller which
provides power to the provides power to the pump and controls pump and controls
operation.operation.
Thoratec Corporation. HeartMate II Patient
Handbook, 2008.
Percutaneous LeadPercutaneous 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 SiteExit Site
The exit site is the The exit site is the location where the location where the percutaneous lead percutaneous lead
goes out through the goes out through the skinskin
Caring for the Perc Lead Exit SiteCaring for the Perc Lead Exit Site
Keep the exit site clean, dry and covered. Keep the exit site clean, dry and covered. Ensure patient and caregiver performing proper hand Ensure patient and caregiver performing proper hand
washing and “aseptic technique” when changing bandage washing and “aseptic technique” when changing bandage or handling the exit site.or handling the exit site.
Keep perc lead stabilized using Stabilization Belt.Keep perc lead stabilized using Stabilization Belt. Protect the system controller from falling or from pulling on Protect the system controller from falling or from pulling on
the lead.the lead. Don’t allow the perc lead to catch or snag on anything that Don’t allow the perc lead to catch or snag on anything that
will pull or move the lead.will pull or move the lead. Check lead daily for signs of damage.Check lead daily for signs of damage. Report any concerns of damage or infection to patient’s Report any concerns of damage or infection to patient’s
VAD Coordinator.VAD Coordinator.
Assessment of Exit SiteAssessment of Exit Site
Tissue in-growthTissue in-growth DrainageDrainage Surrounding TissueSurrounding Tissue
Assessment of Exit SiteAssessment of Exit Site
Most VAD infections began at the Most VAD infections began at the perc lead exit site.perc lead exit site.
Accurate assessments allow the Accurate assessments allow the health care provider to identify and health care provider to identify and promptly treat driveline infections.promptly treat driveline infections.
If any concerns, please contact If any concerns, please contact patient’s VAD coordinator.patient’s VAD coordinator.
Tissue In-growthTissue In-growth
Refers to amount of tissue growing into the perc Refers to amount of tissue growing into the perc lead.lead.
If complete in-growth, should not be able to If complete in-growth, should not be able to retract back on abdomen and expose any velourretract back on abdomen and expose any velour Can be describe in percentagesCan be describe in percentages
Anywhere from 0 to 100 %Anywhere from 0 to 100 % Problem: Percentages may differ between person Problem: Percentages may differ between person
assessingassessing Can be described as Partial or Complete Can be described as Partial or Complete
Can specify where tissue in-growth is using hours on a Can specify where tissue in-growth is using hours on a clock using circumference of driveline as the clock.clock using circumference of driveline as the clock.
Complete in-growth from 2-6 o’clock positionComplete in-growth from 2-6 o’clock position
Tissue In-growthTissue In-growth
100 % Tissue In-100 % Tissue In-growthgrowth
Or Or
Complete Tissue Complete Tissue
In-growthIn-growth
DrainageDrainage
Important to NoteImportant to Note AmountAmount ColorColor OdorOdor ConsistencyConsistency
Surrounding TissueSurrounding Tissue
Appearance of Appearance of surrounding tissue surrounding tissue
may indicate may indicate presence of early presence of early infection, even infection, even
without drainage or without drainage or fever.fever.
Note any erythema, edema, Note any erythema, edema, blisters, hypergranulation blisters, hypergranulation
tissue etc.tissue etc.
InfectionInfection
Infection is one of the common causes Infection is one of the common causes of mortality in patient’s with VADs.of mortality in patient’s with VADs.
The treatment of VAD related infections The treatment of VAD related infections negatively impacts patient’s quality of negatively impacts patient’s quality of life and length of survival with VAD. life and length of survival with VAD.
Prevention of infection is one of the Prevention of infection is one of the primary goals of patient management.primary goals of patient management.
Risk for InfectionsRisk for Infections
Patients are at an increased risk for Patients are at an increased risk for infection.infection.
Chronic HF, poor nutrition, advanced age, Chronic HF, poor nutrition, advanced age, other co-morbidities (DM, COPD etc.).other co-morbidities (DM, COPD etc.).
Presence of foreign body (VAD and perc Presence of foreign body (VAD and perc lead), trauma to exit site, tension to lead), trauma to exit site, tension to wound edges, poor dressing care wound edges, poor dressing care technique.technique.
Signs of Symptoms of InfectionSigns of Symptoms of Infection
Localized Exit Site:Localized Exit Site: Redness, warmth, tendernessRedness, warmth, tenderness With or without positive culturesWith or without positive cultures New or increased drainageNew or increased drainage
Severe Exit Site Infections or Pocket Infections:Severe Exit Site Infections or Pocket Infections: Fever, Elevated White Blood Cell CountFever, Elevated White Blood Cell Count Purulent drainagePurulent drainage Pain at exit site or over devicePain at exit site or over device Positive wound culturesPositive wound cultures Fluid surrounding perc lead up to the deviceFluid surrounding perc lead up to the device Patient may become septic as a resultPatient may become septic as a result Fluid over device, erythema over pocketFluid over device, erythema over pocket
Progression of InfectionProgression of InfectionLocalizedLocalized
TreatmentTreatmentLocalizedLocalized
Increase frequency of driveline Increase frequency of driveline dressing changes if drainage presentdressing changes if drainage present
Immobilize perc leadImmobilize perc lead Start antibiotics if culture positiveStart antibiotics if culture positive Monitor frequently as outpatientMonitor frequently as outpatient Initiate aggressive wound care Initiate aggressive wound care
modalities: silver impregnated modalities: silver impregnated dressings, ultrasound mist therapy.dressings, ultrasound mist therapy.
Progression of InfectionProgression of InfectionSevere Exit Site/Pocket Severe Exit Site/Pocket
InfectionInfection
Treatment Treatment Severe Exit or Pocket Severe Exit or Pocket
Infections Infections HospitalizationHospitalization IV antibioticsIV antibiotics Aggressive Wound Care ModalitiesAggressive Wound Care Modalities Surgical Drainage of fluid collectionSurgical Drainage of fluid collection
Device Infection/SepsisDevice Infection/Sepsis
TreatmentTreatmentDevice Infection/SepsisDevice Infection/Sepsis
Surgical implantation of antibiotic Surgical implantation of antibiotic bedsbeds
Expose device to allow for constant Expose device to allow for constant drainagedrainage
Device Exchange as last resortDevice Exchange as last resort
Complications of Complications of Persistent Exit Site InfectionsPersistent Exit Site Infections
SepsisSepsis Exposure of deviceExposure of device StrokeStroke DeathDeath
TraumaTrauma
Trauma to perc lead either due to Trauma to perc lead either due to pulling, tearing, or dropping of pulling, tearing, or dropping of equipment may lead to infection, equipment may lead to infection, damage of equipment, or pump damage of equipment, or pump stoppage.stoppage.
Perc Lead FracturePerc Lead Fracture
If complete severing of electrical If complete severing of electrical leads, the pump will STOP!leads, the pump will STOP!
Patients may not survive pump Patients may not survive pump stoppage, or may go into cardiogenic stoppage, or may go into cardiogenic shockshock
Perc Lead FracturePerc Lead Fracture
Perc Lead FracturePerc Lead Fracture
Questions???Questions???
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