Quality Improvement Project to Assess the Effect of Gum Mastic Liquid Adhesive on the Integrity and Durability of Driveline Dressings, Risk of Infection, and Patient Satisfaction

Abstract

Background: Left ventricular assist devices are connected to an external power source via a tunneled subcutaneous driveline. The risk of infection increases each time a compromised dressing is changed. Our goal was to increase dressing durability to 7 days, reduce risk of infection, and promote greater patient satisfaction. Methods: For this quality improvement project of 20 patients with a left ventricular assist device, the control group (n = 10) used a standard dressing kit but extended changes from 2 times a week to 1 time every 7 days. For the intervention group’s kit, we added gum mastic liquid adhesive and liquid adhesive remover and had 2 days of live training. Patients reported weekly. Results: In our project we observed an improvement in dressing integrity at 14 weeks in the intervention group versus control group: intact dressings—96% vs. 44%; edges lifting—4% vs. 48%; detachments—0% vs. 8%. Exit site skin condition was comparable, except bleeding—0% in intervention group vs. 12% in control group. Overall, 98% of intervention group reached 7-day goal (avg dressing durability = 7.01 days) vs. 32% of control group (avg = 4.9 days). Fewer dressing changes extrapolates to potential cost savings of $599.56 per patient annually. Patient understanding of the bundled procedure improved quickly: 80% of dressings were assessed as intact week 1, rising to 96% in weeks 2 to 15. Patients also commented on improved satisfaction. Conclusion: In our quality improvement project with gum mastic liquid adhesive and liquid adhesive remover, we observed favorable results with improved dressing integrity, fewer dressing changes, improved patient satisfaction, and reduced costs.