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1 EXCOR ® Wound Care

1 EXCOR ® Wound Care. EXCOR ® Wound care : General information Wound care following antiseptic standards Proper wound care minimise the risk of infection

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Page 1: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

1

EXCOR®

Wound Care

Page 2: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : General information

Wound care following antiseptic standards

Proper wound care minimise the risk of infection

Perform wound care by a trained group

Intensively instruct patient and relatives in case of out of hospital option

Page 3: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : Intervals

Primary wound healing

POD 1-3 Control wound dressing every dayChange wound dressing depending on used products and the level of bleeding

> POD 3 Change wound dressing every two days

> POD 20

Change wound dressing twice a week

Secondary healing / Signs of infection

Clean wound and change dressing twice a day

Leave a dressing on for a number of days depending on used products and the level of exudate

Page 4: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : Preparation

Sterile working area

Disinfectant

(e.g. Octenisept®; Chlorhexidine)

Wound Irrigation Solution with Polyhexanide

(PHMB; e.g.Prontosan®)

Sterile plaster and adhesive dressing

(e.g. 7x5cm and 10x15cm)

Sterile gauze compresses and drain compresses

Protective clothes

Sterile gloves

Operation mask

Operation gown

Cap

Page 5: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

INCOR® Wound care : Removal old dressing

Prepare all materials on a sterile drape Wear sterile gloves, cap, mask, and gown

Remove old dressing Avoid damage of cannulae, especially if you handle with sharp instruments

Change sterile gloves

Assess wound and take appropriate measures if necessary

Take digital pictures if possible to document changes

Take specimen for culture and sensitivity if signs/symptoms of infection

Page 6: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : Removal old dressing

Clean exit area of the exit sites with sterile gauze compress, tinctured with disinfectant (Octenisept® / Chlorhexidine 0,2%)

Clean EXCOR® Velours with hydrogen peroxide (H2O2)

Clean skin also with sterile gauze compress, tinctured with disinfectant Start at the cannula and move outwards

Wound Irrigation with Polyhexanide Solution (PHMB; e.g.Prontosan®)

Page 7: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : New Dressing

Drainage pad around driveline - slot position to the head

Fix the compress with a plaster Nothing sticky directly on cannula

velour

Effect

Cover the exit site

Page 8: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : New Dressing

Position a longitudinal folded compress around each cannula

Open side pointing upwards

Effect

Cover the exit site Strain relief

Page 9: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : New Dressing

Cushion underneath cannulae

Fix compress with sterile bandage

Effect

Prophylaxis of decubitus

Page 10: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : New Dressing

Cover with sterile compress

Effect

Proper fixing Reduce risk of infection

Page 11: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : New Dressing

Cover completely with adhesive dressing

Fix dressing on right and left side under cannulae and between cannulae

Effect

Proper fixing Reduce risk of infection

Page 12: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

12

EXCOR®

Advanced Wound Treatment

Page 13: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : Prevention of infection

Optimization of preoperative skin antisepsis Standard aseptic sterile technique for implantation Protection of contamination for the VAD components Minimized traffic in OR Optimization of surgical hand disinfection

Fast implantation Secure hemostasis Minimal tissue trauma

Standard aseptic sterile technique for wound dressing change Surgical hand disinfection for wound dressing change Immobilization of cannulae

Page 14: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : Complications in healing

Exit site is too small or too large

Patient loses or gains weight

Additional risk factors (e.g.: diabetes, cachexia)

Page 15: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : Complications following infection

Sepsis

Mediastinitis

Peritonitis

Multi organ failure

Page 16: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care : Signs of infection

Increased or sustained pain

Redness

Swelling

Pus discharge

Page 17: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

4

Skin pulled away from driveline

Large amount of drainage

Large amount of redness

Painful

3

Skin pulled away from driveline

Drainage increasing

Redness increasing

Tenderness

2

Initial tear or trauma to exit site

Drainage - note amount, color, odor

Slight redness

Slight tenderness

1

Skin is incorporated to the driveline

No drainage

Little or no redness

No tenderness

EXCOR® Wound care : Exit site scale

Utah Artificial Heart Program / Intermountain Helthcare

Page 18: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

Wound care

UTAH Scale 2

Drainage Redness

Swab / Blood culture / Antibiogram

AB treatment according to antibiogram

Wound Irrigation withvancomycine (morning)hypersaline solution (evening)

Wound dressing aluminized top layer of dressing (e.g. Metalline®)Wound dressing with properties of hydrophobic interaction (e.g. Cutimed Sorbact®)Antimicrobial Wound Dressing with PHMB (e.g. Suprasorb®X + PHMB)

Documentation

Page 19: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

Wound care

UTAH Scale 3

Infection withexsudate

Swab / Blood culture / Antibiogram

AB treatment according to antibiogram

Wound Irrigation withvancomycine (morning)hypersaline solution (evening)

Wound dressing aluminized top layer of dressing (e.g. Metalline®)Wound dressing with properties of hydrophobic interaction (e.g. Cutimed Sorbact®)Antimicrobial Calcium Alginate Dressing (e.g. Suprasorb®A)

Documentation

Page 20: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

Wound care

Wound pocket near exit site

Wound dressing aluminized top layer of dressing (e.g. Metalline®)

Hyaluronic acid micro-granular compound (e.g. Hyalogran®) or Wound Irrigation with

vancomycine (morning)hypersaline solution (evening)

Documentation

Page 21: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

Wound care

Deep wound defect Wide excision, drainage, and debridement of infected driveline tract

Vacuum-assisted closure system(e.g. KCI V.A.C., Hartmann Vivano)

Documentation

Page 22: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

EXCOR® Wound care

With kind permission of F. Müller, ICU, Universitätsklinikum Heidelberg, Germany

Page 23: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection

Frequently asked questions

Q Do I need to change the dressing frequently to check the wound ?

A It is advisable to leave a dressing on for a number of days depending on used products and the levels of exudate. Examine the dressing carefully. It can be left in place if there is no sign that the dressing is going to leak out. With some dressings you can see the exudates on the back of the dressing. Remember ‘a bad cook often opens the oven door’.

Q Does the dressing heal the wound?

A No, the dressing simply provides the optimum environment for healing to take place. For example, it removes dead tissue, provides a warm, moist environment and reduces the number of bacteria in the wound.

Q Do some wounds require three or more dressings at one time together?

A It is unusual for a wound to need more than two dressings. Try and avoid using any more than two dressings at one time.

Page 24: 1 EXCOR ® Wound Care. EXCOR ® Wound care : General information  Wound care following antiseptic standards  Proper wound care minimise the risk of infection