LVAD driveline exit site infection is an expected consequences and significant limiting factor in long term support.It is believed that driveline trauma is the most common initiator of exit site infections.Trauma is usually in the form of shearing traction or torsion injury caused by common events such as dropping the system control and battery pack,hooking the drive line on a passing object.These stress's then cause disruption then never heals due to additional microtrauma leading to neo-epithelialization and tract formation that is ideal for development of super imposed infection.If the body seals the exit site with proteinaceous matarial, the infection can then extend further along the drive line towards the pump pocket.
Treatment immediately after trauma is immobilization of the drive line to allow the disruption to heal.If a tract is already formed,treatment consisist of anti-biotics and aggressive surgical resection of the tract back to the point of adherence.Anti-biotics alone has not proven effictive.
If the tract is to close to the pump pocket,local surgical excision of the exit site and placement of a drain is performed.If the pump pocket is involed,a drain is placed,the surgery is terminated,and further options are assessed.
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