Ventricular Assist Device Driveline Dressing Protocols: A Need for Standardization

Abstract

Introduction The rate of ventricular assist device (VAD) implantation has increased exponentially. However, VAD related infections are relatively common and adversely affect health-related quality of life and survival. The driveline is a common source of infection as it passes through the skin and directly connects to the VAD. Yet, no rigorous standard of care exists for driveline exit-site management. The purpose of this study was to examine national driveline dressing protocols to identify similarities and differences. Hypothesis We hypothesized that that there would be a great deal of heterogeneity among national driveline dressing change protocols. Methods We performed content analysis of inpatient driveline dressing change protocols from 15 academic high-volume VAD centers across the United States (Table 1). We asked each center to provide their dressing change protocol for clean, dry driveline exit sites in non-allergic patients. A deductive approach was used to create a codebook relevant to VAD driveline dressing changes before coding. We reported frequencies for identified codes from the 15 protocols. Results There was substantial heterogeneity in the VAD driveline dressing protocols reviewed. Only 80% (12/15) of protocols explicitly stated how often the dressing should be changed. Use of sterile technique was required in 100% of programs, but only 53% (8/15) described how to maintain a sterile field. Only 40%, (6/15) of programs required everyone in the room to wear a mask. All protocols used CHG to clean the driveline exit site. However, almost half (47%, 7/15) specified “outward circles” to clean the skin, which is not best practice for using CHG. Over half of the protocols (67%, 10/15) use a dressing change kit and an antimicrobial covering. Conclusion We found substantial heterogeneity in VAD driveline dressing protocols among 15 high-volume U.S. VAD centers. Standardization and inclusion of best practices regarding CHG use may reduce driveline-associated infections. Future studies are needed to determine evidenced-based best practices for VAD driveline protocols to reduce infection.