EXCOR®
Wound Care
1
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
EXCOR® Wound care : Intervals
Primary wound healing
 POD 1-3

Control wound dressing every day
Change 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
EXCOR® Wound care : Preparation
 Sterile working area
 Disinfectant
 Protective clothes
 Sterile gloves
(e.g. Octenisept®; Chlorhexidine)
 Operation mask
 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
 Operation gown
 Cap
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
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®)
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
EXCOR® Wound care : New Dressing
 Position a longitudinal folded
compress around each cannula
 Open side pointing upwards
Effect
 Cover the exit site
 Strain relief
EXCOR® Wound care : New Dressing
 Cushion underneath cannulae
 Fix compress with sterile bandage
Effect
 Prophylaxis of decubitus
EXCOR® Wound care : New Dressing
 Cover with sterile compress
Effect
 Proper fixing
 Reduce 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
EXCOR®
Advanced Wound Treatment
12
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
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)
EXCOR® Wound care : Complications following infection
 Sepsis
 Mediastinitis
 Peritonitis
 Multi organ failure
EXCOR® Wound care : Signs of infection
 Increased or sustained pain
 Redness
 Swelling
 Pus discharge
EXCOR® Wound care : Exit site scale
1
2
3
4
Skin is incorporated to the
driveline
Initial tear or trauma to
exit site
Skin pulled away from
driveline
Skin pulled away from
driveline
No drainage
Drainage - note amount,
color, odor
Drainage increasing
Large amount of
drainage
Little or no redness
Slight redness
Redness increasing
Large amount of redness
No tenderness
Slight tenderness
Tenderness
Painful
Utah Artificial Heart Program / Intermountain Helthcare
Wound care
UTAH Scale 2
Swab / Blood culture / Antibiogram
Drainage
Redness
AB treatment according to antibiogram
Wound Irrigation with
vancomycine (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
Wound care
UTAH Scale 3
Swab / Blood culture / Antibiogram
Infection with
exsudate
AB treatment according to antibiogram
Wound Irrigation with
vancomycine (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
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
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
EXCOR® Wound care
With kind permission of F. Müller, ICU, Universitätsklinikum Heidelberg, Germany
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.