Prevention and Management of Driveline Infections in Ventricular Assist Device Patients: The DESTINE 2.0 Staging...

Driveline infections (DLIs) remain the predominant device-specific complication in patients supported by left ventricular assist devices (LVADs) serving as a major source of morbidity, recurrent hospitalization, and mortality. Despite their clinical impact, the prevention and early management of DLIs lack standardization, particularly within outpatient and home-based care environments.

The original 2020 DESTINE proposal introduced a standardized dressing protocol and a prevention-oriented staging system for driveline exit-site management. However, subsequent clinical real-world experience revealed limitations, including overly complex early-stage subcategorization and the absence of contemporary guidance on wound care, including fixation strategies, antiseptic agents, and adjunctive therapies.

DESTINE 2.0 provides expert recommendations to address these gaps. The updated framework features a streamlined five-stage system that consolidates previous subcategories into unambiguous, actionable clinical stages. Enhanced recommendations are provided for driveline immobilization, stage-stratified antiseptic agent selection, and skin barrier preservation. Furthermore, the protocol incorporates adjunctive therapies including cold atmospheric plasma and closed-incision negative pressure wound therapy. Expanded guidance covers modifiable patient-level risk factors, perioperative prophylaxis, showering safety, caregiver education, digital documentation, and stage-directed antibiotic therapy.

By providing a practical, integrated framework applicable to multidisciplinary care settings, DESTINE 2.0 aims to optimize infection-free survival, minimize healthcare utilization, and improve quality of life for patients on long-term mechanical circulatory support.