Bernhardt et al reported a staging system for driveline infections related to a ventricular assist device (VAD). Each stage has a corresponding action plan. The authors are from multiple institutions in Germany
Patient selection: ventricular assist device (VAD)
Clinical Status
Stage
asymptomatic
0
local wound healing disorder
1
local infection
2
systemic infection
3
systemic infection, severe
4
progressive system infection with deep driveline infection or sign of ascending infection
5
Site of exam: driveline exit site (DLES)
Status
Stage
DLES bland and dry with no erythema and no microbial detection
0a
visually unremarkable DLES with no erythema; microbiological positive
0b
dry DLES with erythema
1a
wet DLES without erythema
1b
local infection; erythema, pruritis, swelling; no pyrexia; blood cultures negative; microbial tests at DLES negative
2a
local infection; erythema, pruritis, swelling; pus; no pyrexia; blood cultures negative; microbial tests at DLES positive
2b
signs of systemic infection; erythema and pruritis at DLES; skin tenderness; pus; pyrexia; positive blood culture; microbial tests DLES positive
3
severe signs of systemic infection; positive blood and DLES cultures; bleeding from granulation tissue; possible phlegmone; significant pus
4
similar to Stage 4 plus progressive systemic disease or deep drive line infection or signs of ascending infection
5
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