Prevention of Wound Infection in a Child with a Mechanical Circulatory Support Device awaiting a Heart Transplant

Cardiomyopathy is rare in children, with 6 to12 cases per million ². When maximal medical therapy and routine surgical interventions fail, heart transplantation is the final option.  The use of Extracorporeal Membrane Oxygenation and ventricular assist devices (VAD) as a bridge to transplantation in  pediatrics has increased.  Mechanical circulatory support devices (MCSD) offer improved survival with a significant impact on children  awaiting a heart transplant ⁵.  Majority of deaths for children awaiting surgery are due to progressive multiple end organ failure and infection ⁴.  Infection is a frequent adverse event and results in a temporary inactive status on the transplant list.  Preventing infection begins with meticulous wound care during the time of VAD implantation ³.  The 2  pediatric  devices are the Berlin Heart or Thoratec.  Choice is based on patient size and weight. VAD’s in children are external pumps with 2-4 cannulas depending on left or biventricular support.

          An 11 year old girl underwent successful heart transplantation after her circulation had been supported with a MCSD device for 46 days.  Sterile dressings were coordinated with team assessment and changed daily for three days then weekly.   Sterile towels were placed around the insertion site; each site was cleansed for 30 seconds in a 3 inch circular area using chlorhexidine.   A silicone dressing  applied with the adhesive side between the cannulas, centering the crease to the skin.   Next,  the dressing was folded around each cannula sealing the edges.  Silicone pad was placed under the cannulas avoiding pressure on the chest.  She remained infection and wound free enabling her to undergo heart transplantation.  Seven patients in the past three years with  VAD’s  received the above dressing care.  90% of the patients had VAD in place for >30 days and 100% were infection free.    Interventions in wound care preoperatively is imperative to diminish infection¹.