Change in Caregiver Increases Risk for Driveline Infection

Purpose Driveline infections (DLI) continue to be a significant complication for LVAD patients despite ongoing research and advances in DL management. We sought to identify psychosocial factors, including role of caregiver, that increase risk to development of DLI. Methods This is a single center retrospective case review study that evaluated the 104 active patients at our center. LVAD support ranged from one month to eight years. The presence or absence of DLI was determined according to INTERMACS definition. Patients’ psychosocial risks were assessed in several domains including compliance, transportation, financial, cognitive, and behavioral. We also examined who performed the DL dressing changes at home. A change in caregiver included any individual completing the DL dressing change that was not the caregiver trained to provide DL care during the initial implant hospital admission. Results There were 101 patients with an identified caregiver on implant. Of these patients, 21 had a change in caregiver completing the DL dressing change since the time of implant. In total, 12 of those patients (57%) had developed a DLI. Of the 80 patients with a consistent caregiver from the time of implant, only 11 (14%) had a DLI. When patients had either financial concerns or difficulties with transportation there was a 50% chance that they would develop a DLI. If cognitive/memory deficits were present as assessed by MoCA there was a 39% risk of DLI. Conclusion Psychosocial factors are important determinants of whether LVAD patients develop DLIs. Changes in social support after discharge can lead to inconsistencies in DL care. Consistency in the person performing DL care may be more important than the methods and materials used for DL care.