MANAGEMENT OF LVAD DRIVELINE SITE USING THE VACUUM-ASSISTED CLOSURE DEVICE

Abstract

Percutaneous 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 or draining driveline wounds is a challenge. The KCI Vacuum-Assisted Closure (VAC) device is a non-invasive negative pressure therapy that promotes the healing of wounds not responding to conventional treatment. VAC therapy has proven safe, effective and cost efficient by decreasing the number of dressing changes and length of stay. A 70-year-old destination patient had chronic drainage from the driveline exit site preventing closure. The LVAD team initiated VAC therapy. The tunneling method allowed the wound to heal from the inside out. The dressing was changed every 3 days monitoring the size and depth of the wound. Upon approval for the portable VAC the patient was discharged home. The Home Health Nurse visited the patient 3 days after discharge and noted complete wound closure around the driveline site. The VAC device was removed after 10 days when wound closure was complete. The patient has been followed for five months since VAC therapy was used. The driveline site remains infection free. The experience suggests the VAC device can be used for draining and tunneling LVAD driveline site wounds and may prevent fistula formation. The site showed increased granulation, decreased drainage, and a reduced bacterial burden after having the device in place. Patients may be sent home using a portable VAC device until wound closure is obtained decreasing the hospital length of stay.