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), Cleveland Clinic. (2009). Ventricular assist devices (VAD). Retrieved from s.aspx Drexel Medicine (2014). Ventricular assist devices (VADs) at drexel medicine. Retrieved from 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), 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),

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