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

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Table 4. Definitions of MCSD Specific Percutaneous Driveline Infection Surgical/histology Microbiology Clinical General wound appearance A. Superficial MCSD specific Percutaneous Driveline Infection Proven = Surgical/histology Involvement of tissues Aseptic skin culture Local increase in Purulent discharge criteria ± other criteria superficial to the fascia and positive or not cultured temperature around the from the incision but muscle layers of the incision exit site not involving fascia documented or muscle layers, or Erythema spreading around the exit site a Probable = No Surgical debridement not Aseptic skin culture Local increase in Purulent discharge surgical/histology criteria with performed positive or negative but temperature around from the incision but purulent discharge ± other criteria No histology patient already on antibiotic or had antiseptic used to clean wound the exit site and Treated as superficial infection with clinical not involving fascia or muscle layers or Erythema spreading around the exit site a response Possible = No Surgical debridement not Aseptic skin culture Local increase in No discharge surgical/histology or purulent discharge ± other criteria performed No histology positive or negative and patient not on antibiotics temperature around the exit site and Erythema spreading around the exit site a or had antiseptic used to clean wound Treated as superficial infection with clinical 52
B. Deep MCSD-specific Percutaneous Driveline Infection response Proven = Surgical/histology criteria ± other criteria Involves deep soft tissue (eg, fascial and muscle Culture positive or histology puncture Temperature >38°C or A deep incision spontaneous layers) on direct positive for infection Localized pain or dehiscence examination or on direct examination during reoperation tenderness Abscess deep to the incision around the driveline An abscessis found on direct examination during re-operation Probable = No No surgical debridement Culture negative but Temperature >38°C An incision spontaneous surgical/histology criteria with No histology patients already on or dehiscence spontaneous dehiscence ± other criteria antibiotics or had antiseptic used on exit Localized pain or tenderness and site Treated as a deep infection Possible = No No surgical debridement Cultures not reserved Localized pain or Positive ultrasound surgical/histology criteria with No histology tenderness and positive ultrasound ± other clinical criteria Treated as a deep infection with clinical response a Erythema excluding stitch abscess (minimal inflammation and discharge confied to the points of suture penetration). Reprinted with permission from Hannan MM et al. J Heart Lung Transplantation 2011;30:375-384. 87 53
Page 1 and 2: Task Force 4: Inpatient Management
Page 3 and 4: additive benefits on mean pulmonary
Page 5 and 6: Recommendations for Neurohormonal B
Page 7 and 8: in Task Force 3. Some surgeons elec
Page 9 and 10: MCSD surgery is advised. 19 Preoper
Page 11 and 12: catheter care. 34 The same techniqu
Page 13 and 14: 3. Pre-albumin and C-reactive prote
Page 15 and 16: those patients with learning disabi
Page 17 and 18: may also be related to the type of
Page 19 and 20: appointments after discharge from M
Page 21 and 22: domains of HRQOL (e.g., depression,
Page 23 and 24: For patients who present with gastr
Page 25 and 26: amenable to endoscopic or surgical
Page 27 and 28: INTERMACS also mandates administrat
Page 29 and 30: 6. Discontinuation or reversal of a
Page 31 and 32: Infectious Issues The classificatio
Page 33 and 34: Level of Evidence: B. 3. A possible
Page 35 and 36: Recommendations for Inpatient Treat
Page 37 and 38: could be actuated with a hand pump
Page 39 and 40: heparin, or a heparin-alternative,
Page 41 and 42: Level of Evidence: C. Class II: 1.
Page 43 and 44: 19. Holman WL, Rayburn BK, McGiffin
Page 45 and 46: 60. McGrady A, McGinnis R, Badenhop
Page 47 and 48: 98. Cadeiras M, Nagaraj H, Kirklin
Page 49 and 50: Table 1. Causes of Deviation from N
Page 51: Table 3. Determination of MCSD Infe

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