Challenges in the Perioperative Care of the Ostomy Patient with a Left Ventricular Assist Device

BACKGROUND:

       Care of the patient with a Left Ventricular Assist Device (LVAD) and an ostomy requires a multidisciplinary approach in evaluating the needs that may arise before and after each surgery.  Traditionally, ostomy stomas and LVAD drive lines both require placement within the left or right abdominal quadrants.  This challenges the typical approach in the care of these devices.  Patients may be more prone to life-threatening infections of the LVAD due to close proximity of the ostomy stoma.  There are no documented cases of how to best approach the care of these patients to facilitate the best outcomes.

 METHODS:

         Three cases were highlighted of patients with an LVAD and an ostomy.  Due to the importance of keeping a drive line site sterile, measures were taken to ensure a proper ostomy pouch adherence to reduce the risk of leakage and contamination.  Adjustments were made in stoma site location, pouching procedures, and LVAD holster types to ensure all items were working effectively.  Care of these patients included marking the abdomen for placement of the new ileostomy on the left lower quadrant after consulting with the surgeon since the LVAD drive line was on the right side, changing a holster to a shoulder bag to eliminate pressure on the ostomy pouch, and utilizing a vest with several pockets that was purchased from a regular clothing line.

 RESULTS:

      The adjustment of the stomal site location and obtaining a different battery pack holster type resulted in better pouch adherence, minimal leak occurrences, and decreased drive line infection risk. 

 DISCUSSION:

     It is imperative that ostomy management and care of these devices is undertaken in a coordinated collaborative fashion in order to prevent complications.  The surgeon, wound/ostomy nurse, and transplant coordinator all played important roles to ensure positive outcomes for each patient.