A study at Dignity Health Mercy General Hospital showed that use of a special liquid adhesive to increase the durability of driveline (DL) dressings can reduce the risk of infection and improve quality of life for heart failure patients with left ventricular assist devices (LVADs). Results of the study were presented at the 67th Annual Conference of the American Society for Artificial Internal Organs (ASAIO), June 8-11 in Chicago, where the study was recognized as one of the meeting's top scoring posters with a 2022 ASAIO Poster Abstract Award.
LVADs have revolutionized the treatment of advanced heart failure, but they are also complicated and carry a substantial risk of infection. We found that use of the liquid adhesive to make the exit site dressings last longer both protects patients from the risk of infection and reduces the amount of time they spend changing their dressings. While it may seem small, this allows them to maintain a more active lifestyle and can have a huge impact on their overall quality of life."
Abigail Vowels, RN, BSN, lead study author, Circulatory Device Program Leader at Mercy General Hospital
Since 2012, more than 2,000 LVAD implants have been performed each year in the U.S. to help advanced heart failure patients who are awaiting a transplant, or to improve symptoms for patients who are not transplant candidates. A mechanical pump is implanted in the heart and connected to an external controller and power source by a tube that passes through the skin, called the driveline.
While LVADs are now the standard of care, alongside a heart transplant for advanced heart failure patients, they pose large risks of bleeding and infection, with 1 in 6 patients developing an LVAD-related infection within the first year. Driveline infections are the most common type of infection because the exit site creates an entryway for bacteria and the prosthetic material of the tube creates an ideal environment for bacterial growth. Patients must regularly change the dressing covering the exit site, usually once the dressing is compromised (with its edges lifted or partially detached), but there are no clearly defined clinical guidelines for managing these types of dressing changes.
In the new Mercy General Hospital study, the LVAD team divided 20 LVAD patients into two groups. The control group used a standard dressing kit and changed the dressing once a week. For the intervention group, researchers added a gum mastic liquid adhesive (Mastisol® Liquid Adhesive, Eloquest Healthcare) and liquid adhesive remover (Detachol® Adhesive Remover, Eloquest Healthcare) to the current driveline dressing kits. They also provided live hands-on training as well as instructional handouts and videos for reference.
After 14 weeks, the gum mastic liquid adhesive group showed significant improvements over the control group. The dressings that used gum mastic liquid adhesive lasted an average of 7.01 days compared to 4.9 days in the control group. In addition, 98% of patients went 7 days with their dressings intact, compared to just 32% of the control group. The patients' skin condition was comparable in both groups.
Fewer dressing changes brought significant annual cost savings. Perhaps more important, patients report major improvements.
"The adhesive has made my life wonderfully easier because I spend less time worrying about infections or changing my dressings," said study participant Clayton Elderts, a 72-year old Rio Vista resident who received an LVAD implant in November 2020. "It's easy to use and creates an airtight seal, which provides extra protection against contamination and makes the dressing last longer. It works better than anything else I've used to keep my dressings intact."
As a result of the study's positive outcomes, plans to pilot the use of the liquid adhesive and remover in the LVAD dressing kits at other LVAD programs throughout CommonSpirit Health are currently in progress.
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