New Treatment for Percutaneous Sites in Patients with a Ventricular Assist Device: Nihon University Crystal Violet Method

Abstract

Background: Infection of the percutaneous site of a ventricular assist device (VAD) is a challenging complication. We report our experience with crystal violet Solbase (Nihon University crystal violet method) for prevention of driveline or cannula infections in VAD patients. Patients and Methods: The crystal violet method was used in 10 patients (prophylaxis in nine and treatment in one). Eight patients had an extracorporeal VAD (Nipro) and two had an implantable VAD (Heart Mate II). Results: The infection-free period was 4-623 days (mean: 144.2 ± 222.9 days). All eight patients with an extracorporeal VAD died, while the two patients with an implantable VAD (Heart Mate II) survived. Infection was improved in a patient with MRSA, and the results of bacteriological examination were always negative in the patients receiving prophylaxis. The two patients with an implantable VAD had no infection for 2 and 20 months after implantation. Conclusion: These findings suggest that the Nihon University crystal violet method is effective for prevention and treatment of driveline or cannula infections in patients with a VAD.

Ventricular Assist Device-Specific Infections

“…Superficial driveline infections without evidence of systemic illness or bloodstream infections may be treated with either empiric or microorganism-specific antibiotics [ 45 ]; ISHLT consensus recommends oral or intravenous antibiotics for a minimum of 2 weeks [ 72 ]. Topical antimicrobial strategies, such as using crystal violet solbase and cold atmospheric plasma topical treatment, and negative pressure wound therapy have also been investigated for superficial driveline infections and some success has been achieved [ 121 , 122 ]. Clinical efficacy of these strategies, however, was based on studies of very small sample sizes and will need further validation by large-scale clinical trials [ 121 , 122 ].…”

“…Topical antimicrobial strategies, such as using crystal violet solbase and cold atmospheric plasma topical treatment, and negative pressure wound therapy have also been investigated for superficial driveline infections and some success has been achieved [ 121 , 122 ]. Clinical efficacy of these strategies, however, was based on studies of very small sample sizes and will need further validation by large-scale clinical trials [ 121 , 122 ].…”

Left Ventricular Assist Device Infections

“…Site infections and driveline infections are typically managed with local wound care and a combination of intravenous then oral antibiotics if possible as dictated by the organism isolated from the infected site. Percutaneous site infections have even been treated with topical agents such as crystal violet [85]. Sometimes the tunnel must be excised, and a new tunnel created with the application of a vacuum wound device to close the defect.…”