Ventricular Assist Device:Intervals for dressing changes

By. Megan Giska

What is a VAD?

• A ventricular assist device (VAD) is a mechanical pump that is used to support heart function and blood flow in patients who have heart failure (Cleveland Clinic, 2009).

• The device takes blood from a lower chamber of the heart and helps pump it into the body and vital organs (Cleveland Clinic, 2009).

Who gets a VAD?

• A VAD can be used as a bridge-to-transplant, which means it can help a patient survive until a donor heart becomes available for transplant (Cleveland Clinic, 2009).

• Bridge to recovery: using a VAD to support a patient until their own heart recovers and the VAD can be removed (Drexel Medicine, 2014)

• Or destination therapy, the VAD will provide long-term support in patients who are not candidates for transplant (Cleveland Clinic, 2009).

Types of VADs

• Pulsatile VADs: pumps in a similar way to the heart. Fills with blood and then pumps it forward.

• Non-pulsatile VADs (continuous flow VADs): have a propeller inside that spins to push the blood forward (Drexel Medicine, 2014).

How does the VAD work?

• A left ventricular assist device (LVAD) receives blood from the left ventricle and delivers to the aorta.

• A right ventricular assist device (RVAD) receives blood from either the right atrium or right ventricle and delivers it to the pulmonary artery.

• Some VADs can perform either function or both (BiVAD) (Cleveland Clinic, 2009).

The HeartMateII

• First non-pulsatile VAD approved by the FDA for long term use.

• Improved durability, decreased risk of infection, and smaller size.

• Requires blood thinners (Drexel Medicine, 2014).

Components of the VAD

• Outflow tube- attached to the aorta

• Inflow tube- attached to the apex of the left ventricle

• Power source- either electrical or battery powered.

• Pump unit• Driveline- passes from the

internal device through the skin and outside your body to the controller.

• External controller- (outside) monitors the pumps function (Cleveland Clinic, 2009).

Care of the VAD

• The caregiver and the patient wears a facemask. • Sterile gloves are used to apply the chlorhexidine and

saline swabs are used to clean the circular area around the exit site and the driveline (Sharma et al., 2012).

• The driveline is covered with two 4x4 inch sterile gauze sheets with slits cut in them for passing around the driveline (Sharma et al., 2012).

• The patient wears an abdominal binder at all times to prevent inadvertent pull on the driveline (Sharma et al., 2012).

• This is taught to the patient or family member so they can perform this dressing change once discharged.

Dressing Change

• At TGH the protocol is to change the dressing everyday, using sterile technique.

• This length of time and type of dressing change varies by hospital.

• What is the best length of time to change the dressing to prevent infection?

Case Study #1

• One study evaluated two different time interval protocols for dressing changes in patients who had undergone bone marrow transplantation (Camp-Sorrell, 2007).

• Those with tunneled catheters had dressing changes every 5 to 10 days (Camp-Sorrell, 2007).

• Those with non-tunneled catheters had dressing changes every 2 to 5 days (Camp-Sorrell, 2007).

Outcome

• The increased time interval between dressing changes did not increase the incidence of local infection (Camp-Sorrell, 2007).

• However, significant patient discomfort was decreased with the increase in dressing change time interval (Camp-Sorrell, 2007).

• The biggest problem identified in the study with extending the interval was dressing adherence (Camp-Sorrell, 2007).

Case Study #2

• Comparing Utah Artificial Heart Program protocol of dressing changes every third day to the University of Minnesota protocol of daily sterile dressing changes (Hozayen, Soliman, & Eckman, 2012).

• This study was done as a quality improvement project.

• To compare patient and caregiver satisfaction and rate of infection.

Outcome

• Minnesota patients who received daily dressing changes had less infections with 6 out of 47 patients, compared to Utah who had 3 out of 16 patients with infections (Hozayen et al., 2012).

• Interesting fact: Caregiver satisfaction was higher in the Utah group (every 3 days), with 100% satisfaction rate.

• And patient satisfaction was 81% in the Utah group as well.

Results

• Mixed reviews

• Insufficient data to make “standard of care” recommendations nationally.

• Other factors come into play such as type of dressing, costs, and patient comfort.

References

• Camp-Sorrell, D. (2007). Clinical dilemmas: Vascular access devices. Seminars in Oncology Nursing, 23(3), 232-239.

• Cleveland Clinic. (2009). Ventricular assist devices (VAD). Retrieved from http://my.clevelandclinic.org/heart/disorders/heartfailure/lvad_devices.aspx

• Drexel Medicine (2014). Ventricular assist devices (VADs) at drexel medicine. Retrieved from http://www.drexelmedicine.org/patient-services/cardiothoracic-surgery/services/ventricular-assist-devices/

• Hozayen, S.M., Soliman, A.M., Eckman, P.M. (2012). Comparison of two ventricular assist device dressing change protocols. The Journal of Heart and Lung Transplant 31(1), 108-109.

• Sharma, V., Deo, S., Stulka, J.M., Durham, L.A., Daly, R.C., Park, S.J., Baddour, L.M., Mehra, K., Lyle, J.D. (2012). Driveline infections in left ventricular assist devices: Implications for destination therapy. The Annals of Thoracic Surgery 94(5), 1381-1386.

Questions?