Left Ventricular Assist Devices: An Innovative Approach to Decrease Infections Using a Silver Contact Dressing

Left ventricular assist devices (LVAD) have revolutionized treatment for patients with end stage cardiac failure. These mechanical pumps increase cardiac output by assisting the left ventricle. LVADs are powered by external power sources that connect to the pump via a percutaneous lead (driveline). Despite the benefits of this advanced technology, the exit wound for the driveline places patients at risk for infection.  A collaborative effort between the WOC nurse, LVAD coordinator and cardiovascular team utilized a "silver contact dressing" to improve patient outcomes and promote best practice.     In 2007, 39 patients were implanted with LVADs with an infection rate of 13% in the acute care setting. With the use of "silver contact dressings" in 2008, all 30  LVAD patients experienced no infections. Past management included daily dressing changes with  sterile technique using chlohexidine gluconate 2% to cleanse the site and then applying a nonadherent occlusive dressing.     The plan of care began post-op day one and included a "silver contact layer" wrapped around the driveline at the exit site, and a sterile gauze secondary dressing. The gauze dressing was changed daily but the "silver contact layer" was changed every three days. This continued until the skin at the driveline exit site was healed and there was no more drainage. Once drainage had subsided and the site was healed, a sterile gauze dressing was used and changed weekly and PRN.     Using a "silver contact dressing" during the early post operative course allowed us to reduce our infection rate to 0% using a cost -effective, easy to implement method of care.     The WOC nurse remains an integral member of the cardiovascular team in developing an innovative plan of care for LVAD patients. "Silver contact dressings" on drivelines can greatly reduce the risk of driveline related infections.