Driveline Port area rash

Of course please check with your LVAD team but is the rash "under" the actual bandage or just "inside" the bandage area?  For me, I use Triamcinolone 0.1% which I also use for my eczema.  I apply a small amount around the outside edge of the bandage and it will soak through the skin to help.  My LVAD team also suggested for me to use iodine for sterilizing the area instead of the 2 "lollypop" cleaners that come in the kit.  Verdict still out on the iodine as we just started it last Friday but so far I haven't had any itching.

I was told to let the area 'air out' for 30 minutes when I got rashes.
Everyone is different.

I have been dealing with the same problem for 3 years.  The original products used in the bandage changing routine did not irritate my skin as much as the new kit.  I have isolated each product and hopefully by eliminating the Barrier Film, I will find a more comfortable bandage.

• I have had my LVAD for 4-1/2 years and I have many infections including a fungal, this last year or I have had a rash around the site which is bright red and itchy. Comes and goes.

I also use Triamcinolone occasionally. Not sure if it’s the anchor adhesive or prep. Clears up right away.

James J

Still going nuts trying to figure out what to do. Saw my LVAD team not much help. My personal Dr recommended Silverlon dressing which is a 1.5 x 1.5 piece  that covers your port area with a piece of 2 x2 gauze on top of it. Then a put a piece of tegaderm to cover all of it. Nothing is working!!!! It feels like sandpaper rubbing all day everyday. I don't think these Dr's are hearing me!!! Its not the port area!!! Its the surrounding area. I do use the Triamcinolone cream with every change. The port was fine until they wanted me to start using the Silverlon dressing now the skin is purple colored surrounding the hole. I'm at a loss right now....I geuss I'll just suffer through it day after day.

Lee, can I get a little clarification to make sure we are understanding exactly where this rash is?  I have had multiple problems myself but when I reread this message string I am imagining several different locations.

1. Around the driveline at the entrance into the body.

2. Outside the driveline area but still under the bandage (not bandage adhesive area).

3. Under the actual bandage adhesive area.

4. Outside the bandage adhesive area.

Maybe with this clarification we can better help you.

Hey Stan, 

The rash is around the underside of the tegaderm and the adhesive. I didn't have any rash at the actual entrance site but now I do due to the Silverlon dressing they wanted me to use. (3 changes with the silverlon) Whatever adhesive I use I break out. Its very uncomfortable and I hate to even move.....like I said, it's feels like someone is sanding my body with sandpaper. I am planning on making a call tomorrow to my LVAD team to follow-up with them and honestly I'm not expecting any results, they are baffled by it.

Thanks Stan for your concern and help!!!!

Lee,

Sounds like you are allergic to both the Silverlon dressing and the sterile cleanser in your LVAD dressing kit.  I am also allergic to the sterile dressing in my LVAD dressing kit so I use iodine swabs to clean and then a saline solution to rinse off most of the iodine stain.  The iodine swabs are available from the same place I get my LVAD kits from.  Let us know what your LVAD team says.

BTW, I have also had to get ugly and loud (but never abusive or foul language) with my LVAD team when I feel like they are not listening to me and treat me like a number.  Fact is, we may have another such meeting this month if we don't get something done about a keratin growth I have under the sterile dressing.

Called the LVAD team this morning and as I said, really no help. Explained the situation with the rash since you guys instructed me to use the Silverlon dressing. They are baffled...he said the same thing he has in the last 3 visits. He'll check w/ the team!!! It's getting old. Told him my entrance site was perfect until I started using the silverlon, now it's purple.He wants me to take a picture and send it when i change the dressing. I'll just continue to be uncomfortable!!!

What else can I do?

Afternoon, 

Some of our patient suffer from the same problem. When you use band-aids does that adhesive cause irritation as well? If not you should try band-aids around the areas where the tape sits so the tegaderm isn't sitting directly on your skin. You can also ask your team to give you mepilex to try if the band-aids don't work. We had a patient who had to use the mepilex under the borders of the dressing because it irritated her skin so badly. It did eventually heal. Whatever you use just make sure you are still applying them sterilely. Hope this helps.  :)  

Kind of late to the party, but saw the rash post and I have some insight. I had my LVAD for almost 7 years, did have 1 drive-line infection after switching to Band-Aids due to my rash issues. (I DO NOT RECOMMEND THE BAND-AID ROUTE!!!  That's how I ended up with my infection). It turns out I developed and allergy to the Chloraprep in the wands applicators. After working with my lead LVAD Nurse, she was able to work with the infection department and the wound care team and came up with a product called ExSept Plus. It's made by a company called Angelint. This product changed my life. Once I started using the ExSept instead of the Chloraprep wands, the rashes went away and stayed away. From that point on it was the ExSept to clean, and a Tegaderm to cover. Never had issues after that.

Hi Lee           My husband has super sensitive skin and we have had to make a lot of adjustments to his dressing procedure. One thing we discovered was that the chlorihexadine used to clean the exit site was way too strong. We use about a 1/3 of the initial dose and that has helped sensitivity. It is primarily the dressing itself (Centurion) that he is allergic to. With trial and error we have discovered the Smith and Nephew IV3000 dressing (available from Amazon) which does not cause his skin to react. Because this dressing is only 4X3 we have adjusted to IV split dressing 2X2. The biggest problem with this dressing is the anchoring of the line as it leaves dressing. I have yet to find a perfect solution for that yet so we continue to use the centurion butterfly piece shortened by half and making sure we use "Sure Prep" or Cavillon underneath to lessen reaction. He was also allergic to anchor so now we use the Centurion Foley anchor FCS300XT which is foam based and does not cause rash. Knock on wood - we seem to be able to minimize dressing rash. The other thing that our dermatologist suggested was to take a long acting , non-drowsy anti-histamine which seems to help with any itching, as well as prescription cortisone gel around edges of dressing. Hope some of these ideas help !  Diane

  Hi Lee,

I have been dealing with the same thing for awhile now. My husband does my dressing changes. We both have been observing very closely what is going on. We both noticed that I have no rash around the centurion foley area. I have been using this product for 8 months with no problem. It is a silicone based adhesive. It definitely appears to be only the area where the adhesive sticks around my dressing  which is causing the problems. We have tried changing the tape to different areas but sure enough no matter where the tape is applied -another rash breaks out. I am now using the Triamcinolone cream for the rash which is slowly starting to work. The problem is that I can stop the rash temporarily with this cream but the rash will always reappear where the adhesive is. We have done some research on the silicone based tapes and it is encouraging. My Doctors gave me very specific instructions on how to use this. We are going to use the safe and simple tape from Wound Care Resources. We will use the steroid cream to get rid of the rash first. After that -We are going to switch to the silicone tape just to tape down  the perimeter. Then tape over the whole area with the medipore tape. This should stop the adhesive rash. Using Cavilon is our back up plan. I am feeling very hopeful that this is the solution. I don’t think that people understand how uncomfortable this can be. Losing sleep from itching sensation at night is horrible. I refuse to itch it because that can cause an infection. So far my driveline has been fine.My heart goes out to you. I hope all this gets cleared up soon!
Be well- Joanne L.

Good afternoon 

I have been a rash as well off & on lasts a week or so hasn’t effected my driveline at all just about the size of a half dollar doesn’t bother me enough to worry about 

thank you

Well like  said the fight continues. after receiving the 2 products i used both of them and things have only gotten progressively worse. The Exsept has created a much worse condition then i had. The new dressing isn't working either. I'm about done with it all. I went back today and removed the dressing and went with a 4 x 4 gauze to "air out" the area under it. Maybe I can get a few hours of relief. I think its time to  call the LVAD team and call them OUT!!! Get a referral for a dermatolgist and a wound care specialist.

My husband had a round of severe rash beginning about a month after his surgery.  We do not use the kit at all.  
when the doctor saw it he had us use iodine.  We now use the email 1.5 “ square silverlon disc with a 2” split drainage gauze.  
I also use a 4” split gauze folded into a roll under the driveline to prevent the line from imprinting the skin.  Over that I put anther 4” split gauze folded in half.  We use Hypafix 4” tape.  Now I’m not sure you really need the additional 4” gauze but that is what out LVAD team came up with.  Within 2 days we were seeing results!  No problems since?  Hope this is helpful.  Those rashes are no fun!

I have gone back to using the original products to change my LVAD driveline dressing. First, clean with Hibiclen Solution. Then, Rinse area with Sterile water and finally cover driveline with Tegaderm HP.  The new kits are good for traveling because they are compact and fully sealed but I can not use the products for long.

Hi Harriett, I ordered some of that tape today from amazon. I'm willing to try anything at this point. I also do not and will not use the Centurion LVAD kit. It's horrible. 2x2 and 4x4 gauze is the best so far. My personnel Dr emailed me today and wants to send me to a wound care specialist....I told him to line it up and I'll go.

Well....i'm throwing the towel in. I've tried about everything everyone has suggested to me. To no advil nothing has helped. I'm sitting here right now with no bandage or covering. The rash is raging and it's difficult to even move and type this. I don't know where I go from here. LVAD team is no help... my personel Dr wants to see me but that's not till Feb 3rd. Its absolutley brutal to put any adhesive on me!! This has been going on for months and no one seems to care!!!

Thanks Diane for your concern. I did get some of that dressing and used it...it's all sticky adhesive.There is a smaal discharge from the site and it's hard as a rock, Last appt w/ the LVAD they took a culture and it was negative.The irritation is everywhere the dressing would be, under the adhesive, around the site itself, It's completely exposed cause I cannot even walk with a bandage on it, It feels worst then sandpaper.I did take pics for my Dr and emailed them to him. He referred me to a wound specialist but that was a week ago and haven't head a thing. This horrible.....can't excerise, do things a round the house. I'm stuck in a chair. This has been going on for months and nobody can resolve it. I'm getting tired of living this way!!!!!!!

I'm not trying to call out my LVAD team