What skin care protocols are recommended for patients undergoing TAVR?

Skin Care Protocols for Patients Undergoing TAVR

For patients undergoing Transcatheter Aortic Valve Replacement (TAVR), meticulous skin care is essential to prevent complications, with special attention to vascular access sites and careful handling of the skin to minimize trauma and infection risk. 1

Pre-Procedure Skin Preparation

• Evaluate vascular access sites for potential complications before the procedure 2
• Avoid using adhesive materials on fragile skin when possible
• Document any pre-existing skin conditions or wounds

Intra-Procedure Skin Protection

• Handle skin carefully to minimize epidermal trauma and reduce shearing forces 1
• Avoid using adhesive ECG leads, identification wrist tags, and adhesive dressings when possible 1
• Consider these alternatives to reduce skin trauma:
  • Place thin soft clothing under blood pressure cuffs 1
  • Cover fingertips with clingfilm before attaching oxygen saturation monitors 1
  • Use assistant's hands (over clothing or soft fabric) as tourniquets when needed 1
  • Remove adhesive pads on ECG monitoring leads and secure with soft silicone tape instead 1

Post-Procedure Vascular Access Site Care

• For transfemoral TAVR patients, maintain strict supine positioning until femoral vascular access sheaths are removed and hemostasis is achieved 1
• Monitor access sites closely for:
  • Lower extremity vascular insufficiency
  • Groin hematoma
  • Retroperitoneal bleeding
  • Femoral artery pseudoaneurysm formation 1
• Change peripheral venous cannulas if signs of sepsis or local infection are present, ideally every 2-3 days through non-lesional skin 1
• For central lines, change if signs of infection are present, ideally every 5-7 days through non-lesional skin 1

Wound Management

• Consider soft silicone tapes to attach essential clinical items (cannulas, tubes) 1
• Use silicone medical adhesive remover to remove adherent dressings 1
• Consider soft bandages or tubular bandage to secure dressings and cannulas 1
• Take swabs for bacterial and candidal culture from lesional skin areas, particularly sloughy or crusted areas 1
• For any blisters that form, decompress by piercing and expression or aspiration of fluid while leaving the detached epidermis in place to act as a biological dressing 1

Specialized Care for Different TAVR Approaches

• For transapical TAVR: Prevent postoperative hypertension during and after extubation to decrease risk of bleeding or ventricular rupture 1
• For direct aortic and subclavian approaches: Carefully monitor for mediastinal/thoracic bleeding with particular attention to avoiding postoperative hypertension 1

Pain Management for Skin and Incision Sites

• Use validated pain assessment tools at least once daily 1
• Implement appropriate analgesia regimen immediately after procedure:
  • For transapical approach: Consider intercostal nerve block, wound infiltration with local anesthetics 1
  • For transfemoral approach: Focus on access site pain management 1
• Avoid epidural analgesia for patients on anticoagulants (common in TAVR patients) 2

Monitoring and Follow-up

• Transfer patients to telemetry unit with hemodynamic and ECG monitoring when stable 1
• Implement early mobilization protocols when appropriate to prevent skin breakdown 2
• Maintain adequate hydration to support skin integrity and renal function 1

Special Considerations

• For elderly patients (common in TAVR population), take extra precautions with skin care due to increased fragility 3
• Consider physical therapy assessment for early mobilization to prevent pressure injuries 2

By following these skin care protocols, healthcare providers can minimize complications and improve outcomes for patients undergoing TAVR procedures, particularly regarding vascular access site complications and wound healing.