WOC Collaboration Helps Patient Get His New Heart

Problem: Patient with ventricular assist device (VAD) awaiting heart transplant was admitted for two chest wall abscesses along the VAD driveline. Patient presented with fevers, chills, malaise and elevated INR and underwent incision and drainage of abscesses, resulting in two close but non-communicating wounds with copious drainage. The drainage was overwhelming dressings leading to more frequent and painful dressing changes despite premedication. Due to the infection and open wounds the patient was removed from the heart transplant list. Challenge:WOC assessed patient and believed negative pressure wound therapy (NPWT) would lead to improved wound healing, management of copious drainage, less frequent dressing changes. Upon assessment exposed driveline noted in the inferior wound. A literature review was undertaken to determine if NPWT could be placed against drivelines. WOC collaborated with NPWT representatives, VAD and surgical teams to develop a comprehensive treatment plan. Interventions: This was the first time instillation therapy was used in our institution. WOC specialist reviewed policy prior to placement and found a gap in policy regarding hang time for fluids. WOC collaborated with infection control, clinical pharmacy, protocol and policy management, and venous access team to discuss appropriate hanging time for normal saline. A new standard was established and the policy was updated. NPWT with instillation placed in collaboration with bedside nursing staff, providers and support from NPWT representative providing hands on education and demonstration of this new treatment therapy. Outcomes: Patient admitted one month later for heart transplant and noted to have two small granulating wounds with minimal drainage. Due to rapid healing, patient placed back on transplant list and successfully received a heart. By collaborating with multiple disciplines and establishing an updated protocol and policy, the WOC paved the way for our institution to begin utilizing instillation therapy.