To standardize wound care and prevent infection in compromised patients who have a Berlin Heart Ventricular Assist Device (VAD).

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Carmella Jones
5 years ago
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1 PURPOSE To standardize wound care and prevent infection in compromised patients who have a Berlin Heart Ventricular Assist Device (VAD). POLICY STATEMENTS Dressing change should be done no sooner than 24 hrs after placing implant unless saturated. *Notify Cardiac Surgeon if dressing saturated and requires early intervention. Dressing change is then done daily for days if the wound is dry and not infected. If the wound is draining large amounts and/or appears infected then dressing changes may be needed twice a day. Day 10 or 14-28: dressing changes are done every second day if the wound is dry and not infected. Day 28 + dressing changes are done twice a week if the wound is healing. Adhesive is not to be applied to the velour coating of the cannulae as it is difficult to remove and may adversely manipulate the cannulae. Organic solvents such as chlorinated hydrocarbon are not to be used near the EXCOR Pediatric as they will damage the cannulae and the pumps. Further solvents that might damage cannulae and pumps include but are not limited to benzene, toluene, xylene, acetone and heptane. Proviodine iodine or betadine swabs/ointment are not to be used around drive lines. Cannulae sites are to be treated like open wounds and attended to only by a small core group of health care providers (HCP) competent in Berlin Heart dressing change. Dressing change personnel will require 1-2 helpers to assist. If the patient is awake it may be advised to involve child life to assist with keeping the patient calm and relaxed throughout the procedure. SITE APPLICABILITY Applicable in areas within BCCH where patients with a Berlin Heart implant are cared for: PICU and inpatient unit 3M. PRACTICE LEVEL/COMPETENCIES Berlin Heart dressing change is considered an advanced nursing skill. Only those with validated competency in Berlin Heart dressing changes or the Cardiac surgeon are to perform this procedure. EQUIPMENT Disinfectant wipe 4 packages sterile towels 3 packages of 4x4 sterile gauze sterile in tubs (10 4x4 /tub) Mepilex Ag dressing 10 x 10 cms, (Manufacturer: Molnlycke Healthcare ) People Soft # Item ID % Chlorhexadine solution and swabs (CHG) 1 L bottle NS - warmed Mask Surgical Cap Sterile gown (2) 4 pairs sterile gloves 6-8 sterile Primapore dressings Metalline drain compress Abdominal pad if excess drainage present 2 EZ scrub (surgical scrub) CC BCCH Child & Youth Health Policy and Procedure Manual Page 1 of 5

2 1 pair scissors 1 sterile specimen container Adhesive remover for skin only Non-sting barrier film sticks Tubular bandage PROCEDURE Rationale PREPARATION 1. IDENTIFY patient and, if appropriate, EXPLAIN Reduces anxiety in family and child (if old procedure. enough to comprehend). 2. CLEAN working surface with disinfectant wipe. Routine infection control practices; reduces 3. DON mask and surgical hat. transmission of microorganisms. 4. PUT mask on patient, unless intubated, and any other caregivers present in room 5. PERFORM hand hygiene. 6. SET-UP sterile field on cleaned working surface and OPEN all sterile packages (gauze, towels, gloves, etc.) and PLACE on sterile field. 7. SET-UP tubs on working surface next to but not in contact with sterile field: a. 1 tub of dry 4x4 s b. 2 tubs of 2 % Chlorhexadine DRESSING REMOVAL 8. DON disposable gloves, and REMOVE old dressing Reduces transmission of microorganisms. using aseptic no touch technique. 9. EXAMINE exit site and surrounding skin for signs of Assessing exit site will prevent unnecessary infection swab site if necessary. It may be helpful to delays in providing appropriate interventions. photograph site for future reference. If drainage noted cleanse site with NS prior to swabbing Pay special attention to skin condition underneath cannulae as this is where pressure areas develop. 10. REMOVE any excess adhesive from cannulae, pump and skin (may use adhesive remover on skin). 11. PHOTOGRAPH cannulae exit site weekly or as needed. BLOOD PUMP CLEANING 1. PERFORM 3 minute EZ scrub up to elbows. Dry hands on sterile towel then DON sterile gown. 2. DON sterile gloves - 2 pairs. 3. Using a sterile towel to keep gloved hand sterile LIFT pump head and exposed cannulae and CLEANSE with 2% Chlorhexadine soaked 4x4 s. 4. While still holding cannulae, CREATE a sterile field around drivelines and pumps using sterile towels - then LOWER onto sterile field. 5. REPEAT steps 3 & 4 for the other cannulae Cleansing the wound before collecting a culture swab is done in order to remove surface contaminants. This will not "kill" organisms found in an infected wound. Remnants of adhesive contaminate the cannulae and increase the risk of infection. Adhesive remover is used to prevent skin breakdown. Photos filed in patients chart for reference. Surgical scrub required. This area is exposed to environment and may contaminate cannulae sites. A sterile gloved assistant assists in this step. CC BCCH Child & Youth Health Policy and Procedure Manual Page 2 of 5

6. REMOVE sterile gloves outer layer WOUND CLEANING 1.

General recommendation for cleansing with CHG requires friction in a back and forth manner.

Due to the delicate necessity of secure granulation tissue at the exit site gentle wiping is preferred (reference St Louis Dressing Change) Chlorhexadine has extended bactericidal action 2.

3 6. REMOVE sterile gloves outer layer WOUND CLEANING 1. WIPE gently around exit site of drivelines in a circular motion with 2% Chlorhexadine soaked 4x4 s or swabs working from exit site then outward to a radius of about 10cm repeat 2 more times. General recommendation for cleansing with CHG requires friction in a back and forth manner. The application of friction allows the solution to penetrate the lower layers of the epidermis thus killing a greater number of skin organisms. Due to the delicate necessity of secure granulation tissue at the exit site gentle wiping is preferred (reference St Louis Dressing Change) Chlorhexadine has extended bactericidal action 2. WRAP 4x4 soaked 2% Chlorhexadine around cannulae and gently CLEAN with back/forth motion starting at the exit site moving down cannulae away from patient approximately 10 cm from exit site. 3. REPEAT 3 times for each cannulae. Clean entire cannulae (upper and bottom side). 4. ALLOW Chlorhexadine to dry at least 1 minute. To achieve maximum antiseptic effectiveness. If CHG is not dry, a chemical reaction may occur with the adhesive and cause a skin rash. 5. APPLY non-sting barrier film to skin around cannulae. Non-sting barrier prevents skin maceration around cannulae insertion site. DRESSING APPLICATION 1. WRAP Metalline drain compress around each cannulae. (slit always facing upwards) Note the diagram does not show a Mepilex Ag dressing, which shall be routinely used at BCCH. 2. SECURE top of 4X4 to patient chest using adhesive dressing (Primapore). Complete with each cannulae. Provides support for cannulae preventing pressure areas. CC BCCH Child & Youth Health Policy and Procedure Manual Page 3 of 5

If extra support is needed, place1-4x4 folded into thirds underneath each cannulae. 3.

The open end of the compress should point the skin. in the direction of the wound. REPEAT process on right cannulae. 4.

SECURE with sterile with large Primapore Seals the dressing. 6. PLACE tubular elastic net bandage around patient. Secures the dressing in place.

4 If extra support is needed, place1-4x4 folded into thirds underneath each cannulae. 3. PASS gauze compress (Primapore) beneath the 2 left Cannulae are now padded and do not press on cannulae. The open end of the compress should point the skin. in the direction of the wound. REPEAT process on right cannulae. 4. COVER cannulae with 2x2 or 4x4 gauze dependent of drainage, 5. PLACE abdominal pad over gauze dressing. 6. SECURE with sterile with large Primapore Seals the dressing. 6. PLACE tubular elastic net bandage around patient. Secures the dressing in place. DOCUMENTATION DOCUMENT on appropriate record: date and time completion of dressing change assessment of site and surrounding skin appearance of any drainage noted patient's response to procedure unexpected outcomes and related treatment any other actions or observations CC BCCH Child & Youth Health Policy and Procedure Manual Page 4 of 5

5 REFERENCES St Louis Children s Hospital - Ventricular Assist Device/Berlin Heart Device Dressing Change [06/09]. Berlin Heart - Excor Pediatric Ventricular Assist Device User Manuel [ ] [05/09] Berlin Germany The Children s Hospital of Philadelphia - Ventricular Assist Device/Berlin Heart Device Dressing Change [12/10] USA Texas Children s Hospital - Ventricular Assist Device/Berlin Heart Device Dressing Change [13/07] USA BC Children s Hospital - Child and Youth Manual. Central Line Dressing change [11/10] CC BCCH Child & Youth Health Policy and Procedure Manual Page 5 of 5

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