Left Ventricular Assist Device Driveline Infection and the Frequency of Dressing Change in Hospitalized Patients

Left ventricular assist devices (LVADs) provide a valuable therapeutic option for patients with end stage heart failure who will not survive until a donor organ becomes available or who are not transplant candidates. Due to advanced LVAD technology and improved patient outcomes, the number of LVAD recipients continues to increase annually. This implantable mechanical circulatory support device includes a percutaneous driveline that exits through a puncture in the skin. Driveline exit site infections are known to be a serious complication, yet standardized guidelines for driveline exit site care do not exist resulting in wide variations in care, especially related to the frequency of dressing change.  The purpose of this study was to determine if the frequency of exit site dressing changes is related to the incidence of driveline infection in hospitalized adult patients receiving a newly implanted LVAD.   A retrospective medical record review was conducted to collect information and identify driveline infections on patients that were implanted with a HeartMate® II LVAD between August 2008 and September 2013.  The study took place at an urban academic medical center that implants LVADs and has modified the frequency of dressing changes over a 5 year period.  Eighty-six patients were implanted with a HeartMate® II LVAD. Sixty-eight patients met study eligibility. The Interagency Registry for Mechanically Assisted Circulatory Support criteria for driveline infection were used to define infection. The medical record reviews revealed no acute driveline infections during implant hospitalization or any 30 day readmissions for driveline infection. The frequency of the driveline dressing change varied from daily, three times a week, and weekly.  The daily dressing change group was younger in age compared to the weekly group (p=0.005) and three times a week group (p=0.001). No other differences between the groups were found.  The results of the study indicate that driveline infections do not appear to be related to the frequency of dressing changes in adult patients with a newly implanted LVAD. These data suggest that daily dressing changes are no longer warranted and that organizations should consider up to weekly changes.