1. EXCOR®
Wound Care 1

2. EXCOR® Wound care : General information
Wound care following antiseptic standards
Proper wound care minimise the risk of infection
Perform wound care by a trained group
Intensively instruct patient and relatives in case of out of hospital option

3. EXCOR® Wound care : Intervals
Primary wound healing
POD Control wound dressing every day
Change wound dressing depending on used products and the level of bleeding
> POD Change wound dressing every two days
> POD 20
Change wound dressing twice a week
Secondary healing / Signs of infection
Clean wound and change dressing twice a day
Leave a dressing on for a number of days depending on used products and the level of exudate
Diskussion: Wundverbandwechsel ab dem POD 1? (MM; )

4. EXCOR® Wound care : Preparation
Sterile working area
Disinfectant
(e.g. Octenisept®; Chlorhexidine)
Wound Irrigation Solution with Polyhexanide
(PHMB; e.g.Prontosan®)
Sterile plaster and adhesive dressing
(e.g. 7x5cm and 10x15cm)
Sterile gauze compresses and drain compresses
Protective clothes
Sterile gloves
Operation mask
Operation gown
Cap

5. INCOR® Wound care : Removal old dressing
Prepare all materials on a sterile drape
Wear sterile gloves, cap, mask, and gown
Remove old dressing
Avoid damage of cannulae, especially if you handle with sharp instruments
Change sterile gloves
Assess wound and take appropriate measures if necessary
Take digital pictures if possible to document changes
Take specimen for culture and sensitivity if signs/symptoms of infection

6. EXCOR® Wound care : Removal old dressing
Clean exit area of the exit sites with sterile gauze compress, tinctured with disinfectant (Octenisept® / Chlorhexidine 0,2%)
Clean EXCOR® Velours with hydrogen peroxide (H2O2)
Clean skin also with sterile gauze compress, tinctured with disinfectant Start at the cannula and move outwards
Wound Irrigation with Polyhexanide Solution (PHMB; e.g.Prontosan®)

7. EXCOR® Wound care : New Dressing
Drainage pad around driveline - slot position to the head
Fix the compress with a plaster
Nothing sticky directly on cannula velour
Effect
Cover the exit site

8. EXCOR® Wound care : New Dressing
Position a longitudinal folded compress around each cannula
Open side pointing upwards
Effect
Cover the exit site
Strain relief

9. EXCOR® Wound care : New Dressing
Cushion underneath cannulae
Fix compress with sterile bandage
Effect
Prophylaxis of decubitus

10. EXCOR® Wound care : New Dressing
Cover with sterile compress
Effect
Proper fixing
Reduce risk of infection

11. EXCOR® Wound care : New Dressing
Cover completely with adhesive dressing
Fix dressing on right and left side under cannulae and between cannulae
Effect
Proper fixing
Reduce risk of infection

12. Advanced Wound Treatment
EXCOR®
Advanced Wound Treatment 12

13. EXCOR® Wound care : Prevention of infection
Optimization of preoperative skin antisepsis
Standard aseptic sterile technique for implantation
Protection of contamination for the VAD components
Minimized traffic in OR
Optimization of surgical hand disinfection
Fast implantation
Secure hemostasis
Minimal tissue trauma
Standard aseptic sterile technique for wound dressing change
Surgical hand disinfection for wound dressing change
Immobilization of cannulae

14. EXCOR® Wound care : Complications in healing
Exit site is too small or too large
Patient loses or gains weight
Additional risk factors (e.g.: diabetes, cachexia)

15. EXCOR® Wound care : Complications following infection
Sepsis
Mediastinitis
Peritonitis
Multi organ failure

16. EXCOR® Wound care : Signs of infection
Increased or sustained pain
Redness
Swelling
Pus discharge

17. EXCOR® Wound care : Exit site scale1
Skin is incorporated to the driveline
No drainage
Little or no redness
No tenderness 2
Initial tear or trauma to exit site
Drainage - note amount, color, odor
Slight redness
Slight tenderness 3
Skin pulled away from driveline
Drainage increasing
Redness increasing
Tenderness 4
Skin pulled away from driveline
Large amount of drainage
Large amount of redness
Painful
Utah Artificial Heart Program / Intermountain Helthcare

18. Wound care UTAH Scale 2 Drainage Redness
Swab / Blood culture / Antibiogram
AB treatment according to antibiogram
Wound Irrigation with
vancomycine (morning)
hypersaline solution (evening)
Wound dressing aluminized top layer of dressing (e.g. Metalline®)
Wound dressing with properties of hydrophobic interaction (e.g. Cutimed Sorbact®)
Antimicrobial Wound Dressing with PHMB (e.g. Suprasorb®X + PHMB)
Documentation

19. Wound care UTAH Scale 3 Infection with exsudate
Swab / Blood culture / Antibiogram
AB treatment according to antibiogram
Wound Irrigation with
vancomycine (morning)
hypersaline solution (evening)
Wound dressing aluminized top layer of dressing (e.g. Metalline®)
Wound dressing with properties of hydrophobic interaction (e.g. Cutimed Sorbact®)
Antimicrobial Calcium Alginate Dressing
(e.g. Suprasorb®A)
Documentation

20. Wound care Wound pocket near exit site
Wound dressing aluminized top layer of dressing (e.g. Metalline®)
Hyaluronic acid micro-granular compound (e.g. Hyalogran®) or
Wound Irrigation with
vancomycine (morning)
hypersaline solution (evening)
Documentation

21. Wound care Deep wound defect
Wide excision, drainage, and debridement of infected driveline tract
Vacuum-assisted closure system
(e.g. KCI V.A.C., Hartmann Vivano)
Documentation

22. EXCOR® Wound care
With kind permission of F. Müller, ICU, Universitätsklinikum Heidelberg, Germany

23. Frequently asked questions
Q Do I need to change the dressing frequently to check the wound ?
A It is advisable to leave a dressing on for a number of days depending on used products and the levels of exudate. Examine the dressing carefully. It can be left in place if there is no sign that the dressing is going to leak out. With some dressings you can see the exudates on the back of the dressing. Remember ‘a bad cook often opens the oven door’.
Q Does the dressing heal the wound?
A No, the dressing simply provides the optimum environment for healing to take place. For example, it removes dead tissue, provides a warm, moist environment and reduces the number of bacteria in the wound.
Q Do some wounds require three or more dressings at one time together?
A It is unusual for a wound to need more than two dressings. Try and avoid using any more than two dressings at one time.