Driveline exit-site care protocols in patients with left ventricular assist devices: a systematic review

• Published in: European journal of cardio-thoracic surgery Vol. 60; no. 3; pp. 506 - 515
• Main Authors: Koken, Zeliha Ozdemir, Yalcin, Yunus C, van Netten, Diana, de Bakker, Chantal C, van der Graaf, Maaike, Kervan, Umit, Verkaik, Nelianne J, Caliskan, Kadir
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 11.09.2021
• Subjects: Clinical Protocols; Heart Failure - therapy; Heart Ventricles; Heart-Assist Devices - adverse effects; Humans; Prospective Studies; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - prevention & control; Reviews; Left ventricular assist device; Dressing; Driveline; Protocols; Driveline infection; Care
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezab195

Abstract   OBJECTIVES Driveline infections continue to be a significant complication following left ventricular assist device (LVAD) implantation. Driveline exit-site care is crucial for the prevention of infections; however, there are no uniform guidelines. The goal of this study was to provide an overview of the currently published driveline exit-site care protocols in patients with LVAD. METHODS A systematic literature review was performed. Studies before 15 December 2020 were included if the number of driveline infections was a primary outcome and the driveline exit-site care protocol was explained. RESULTS Eleven articles were included in the systematic review, including 1602 patients with LVADs. The median of the frequency of driveline infections in the articles was 13.8% with a range of 0–52.6%. There was a marked variability in the methods of care of driveline exit sites, without a standardized driveline dressing technique in patients with LVADs. The frequency of driveline infections was 6–7.5% in studies using a dressing kit that included chlorhexidine, a silver-based dressing and an anchoring device. Furthermore, there was variability in the anchoring devices and the frequency of dressing changes, which varied from daily to weekly. No specific anchoring device or change frequency was found to be superior. CONCLUSIONS Based on this systematic review, driveline exit care protocols that included chlorhexidine, a silver-based dressing, the use of an anchoring device and dressing kits might be best in reducing driveline infection rates. However, prospective studies with larger cohorts are needed to establish the optimal protocol for driveline exit-site care.