Infections

• Skin infection at the cable port :
  • The place where the driveline passes through the skin is called the cable port. At this location the skin barrier is broken and chronically there is a possible entry point for a bacterial infection that can ascend along this cable to the heart pump.
  • Good wound care and good chronic local hygiene are very important to prevent such infections. Disinfection, proper drying of the wound and a sterile covering bandage are very important.
  • Alarm symptoms are :
    • Redness and/or pain of the skin at the entrance port or over the subcutaneous route of the cable.
    • Fluid or pus discharge.
    • Elevated temperature.
• Invasive infection of the LVAD :
  • Sepsis.
  • Hospitalization for IV antibiotics.
  • Sometimes an indication for explantation and replacement of the heart pump.

Gastrointestinal bleeding

• Stop warfarin and aspirin.
• No vitamin K supplements (Konakion).
• If necessary, blood transfusion if hemoglobin < 8 g/dl.
• Detecting the source of the bleeding, especially in the case of the first gastrointestinal bleeding.
• Restart blood thinning as soon as possible.

TIA or CVA

• Only CT-scan of the brain is possible, no MRI-scan of the brain.
• Do not give heparin.
• TIA: therapy continues unchanged.
• Mild to severe stroke: stop warfarin and aspirin for 3 to 12 days to prevent hemorrhagic transformation.
• Hemorrhagic stroke: stop warfarin and aspirin - restart warfarin after about 2 weeks, without restarting aspirin.

Heart pump thrombosis

• Symptoms :
  • Clinical deterioration.
  • Very dark urine (cola color) due to hemolysis. Then check LDH and free plasma hemoglobin.
• This is sometimes an indication for explantation and replacement of the heart pump.