Case Series: Clinical Management of Persistent Mechanical Assist Device Driveline Drainage Using Vacuum-Assisted Closure Therapy

Abstract

Percutaneous driveline lead and pocket sites are potential sources of drainage that can lead to infection. Some patients experience a slower closure of tissue growth into the driveline. The management of chronically open and or draining driveline wounds is a challenge. The KCI vacuum-assisted closure (VAC) device is a noninvasive negative-pressure therapy that promotes the healing of wounds not responding to conventional treatment. Vacuum-assisted closure therapy has proven safe, effective, and cost efficient by decreasing the number of dressing changes and length of stay. The left ventricular assist device (LVAD) team initiated VAC therapy in 3 patients. The tunneling method allowed the wound to heal from the inside out. The dressing was changed every 3 days, and the size and depth of the wound was monitored. Patients may be sent home using a portable VAC device until wound closure is obtained, which decreases the hospital length of stay. Our experience with three patients suggests the VAC device can be used for draining and tunneling LVAD driveline-site wounds and may prevent fistula formation. It is especially useful for patients with ascites that may be draining along the driveline tract. The sites showed increased granulation, decreased drainage, and a reduced bacterial burden after having the device in place.

Continuous-flow devices and percutaneous site infections: Clinical outcomes

“…Vacuum-assisted closure for PSI was first reported by Yuh et al 19 and has now become a very useful addition to the limited armamentarium of surgical options to control or eradicate these PSIs. 20,21 Surprisingly, we found that traditional factors associated with surgical infections, such as female sex, 22,23 diabetes, 24,25 acuity of illness, malnutrition (very low BMI), or obesity (high BMI), 26,27 were not predictive of PSI. This observation counters the finding by Raymond et al, 4 who suggested that patients with higher BMIs and continued weight gain after LVAD implantation had higher incidence of PSIs than a control group.…”

Effect of Left Ventricular Assist Device Infection on Post-transplant Outcomes

“…20 It has been proven safe, effective and cost-efficient, and the patients for whom it has been applied have shown increased granulation, decreased drainage and a reduced bacterial burden. 21 Ultimately, as suggested in the CUBS trial, a transition to fully implantable devices without percutaneous conduits may be a better alternative.…”

Cardiac assist device infections

“…In the presence of a chronic indwelling percutaneous device, skin healing is impaired and the wound may not completely seal. Poor wound closure may be exacerbated by persistent, noninfectious drainage from the driveline site from fl uid collections around the mechanical assist device, ascites, repetitive trauma at the exit site, and anasarca [23]. Disruption of vital anatomic barriers provides a conduit for infecting pathogens.…”