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Review
. 2014 Nov;3(6):557-62.
doi: 10.3978/j.issn.2225-319X.2014.09.08.

Technique for minimizing and treating driveline infections

Leora T Yarboro  1 , James D Bergin  1 , Jamie L W Kennedy  1 , Carole C Ballew  1 , Emily M Benton  1 , Gorav Ailawadi  1 , John A Kern  1
Affiliations
Review

Technique for minimizing and treating driveline infections

Leora T Yarboro et al. Ann Cardiothorac Surg. 2014 Nov.

Abstract

Left ventricular assist devices (LVADs) are increasingly utilized in the management of advanced heart failure. A transcutaneous driveline is necessary to power the LVAD, and although this technology has improved over the years in terms of smaller size and increased durability, driveline complications continue to develop in up to 20% of all devices implanted. Driveline infections are associated with significant morbidity and mortality. As more patients live longer with ventricular assist devices, minimizing driveline infections is paramount. A systematic, multidisciplinary approach can be used to develop a strategy to prevent, recognize and treat driveline infections. In this paper, we describe our approach to driveline management which has resulted in zero driveline infections between January 2012 and March 2014.

Keywords: Circulatory support; heart failure; perioperative care; quality care management.

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Figures

Video 1
Video 1
Technique for minimizing and treating driveline infections.
Figure 1
Figure 1
Early technique of securing driveline. Prolene anchoring suture resulted in significant driveline crimping that persisted, even after removal of the stitch.
Figure 2
Figure 2
A piece of red rubber catheter prevents driveline crimping by the anchoring sutures.
Figure 3
Figure 3
Driveline management system (left) and daily exit site management protocol (right) provide a standardized routine for driveline management.
Figure 4
Figure 4
The prolene anchor is replaced with a soft anchoring device at one month postoperatively.
Figure 5
Figure 5
Driveline repositioning for distal driveline exit site infections. The infected area is excised and driveline repositioned to a new site. Negative pressure dressing is used to heal the previous exit site.
Figure 6
Figure 6
Zero driveline infections have been noted in the outpatient population from January 2012 to March 2014. LVADs, left ventricular assist devices.
See this image and copyright information in PMC

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