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

BACKGROUND: 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. METHODS AND OBJECTIVES: 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. UPDATED RECOMMENDATIONS: 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. CONCLUSION: 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.