Task Force 4: Inpatient Management of Patients with MCSD - The ...

after cardiac transplantation. 29 It should be noted that patients with MCS were not
specifically addressed in this consensus statement. Since the burden of developing
bacteremia is high in patients with MCS, secondary prophylaxis is reasonable and
remains at the discretion of the physician.
Driveline Care. Drivelines and external cannulas are usually covered with
Dacron-velour which stimulates subcutaneous growth and sealing of the skin. 8 Due to
concerns that the velour may promote settling of bacteria at the skin incision and result
in infection, some surgeons have elected to bury the velour beneath the skin and bring
the silastic coated part of the driveline through the incision.. It is important for the wound
around the driveline to heal without gaps so pathogens cannot penetrate. The purse
string suture around the driveline should be left in place for up to 30 days.
Most driveline infections start with local trauma that disrupts the integrity between
the driveline and surrounding skin, usually by accidental pulling of the driveline. 30
Patients have to be educated to care for their drivelines and avoid trauma.
Immobilization of the driveline is important, and in case of local trauma, the VADcoordinator
has to be notified so infection prevention measures can be taken. 30 In some
centers, immobilization of drivelines is performed immediately after the device is placed
and before the patient leaves the operating room. 31 A Foley catheter anchor may be
used to secure the driveline, and often two anchors are applied to minimize movement
at the exit site. The driveline site should be covered during bathing or showering until
the wound is completely healed; 8 some advocate no showering for 30 days after
surgery or until the driveline site is completely healed. 32 When there is formation of a
gap between the driveline and surrounding tissue, it will not form new epithelium and
healing would be impossible unless the tissue is debrided. 30
Protocols for the Care of the Driveline Exit Site. There are no universally
accepted protocols that address wound care of the driveline exit site. Dressing changes
should be done daily or every other day, and the site should be monitored carefully for
any sign of infection. 32 Most commonly, cleaning is done with chlorhexidine and gauze
is placed to cover the exit site. 33 For patients sensitive to chlorhexidine, hydrogen
peroxide may be substituted. At the University of Pittsburgh Medical Center, a protocol
for dressing changes was adapted from management of long-term hemodialysis
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