Turkiye Klinikleri Cardiovascular Sciences

.: REVIEW
Major Complications and Nursing Care of Patients Implanted Left Ventricular Assist Device
Sol Ventrikül Destek Cihazı İmplante Edilen Hastalarda Major Komplikasyonlar ve Hemşirelik Bakımı
Fatma DEMİR KORKMAZa, Nihal ÇELİKTÜRKa
aDepartment of Surgical Nursing, Ege University Faculty of Nursing, İzmir, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(3):130-8
doi: 10.5336/cardiosci.2020-75535
Article Language: EN
Full Text
ABSTRACT
Heart failure is an important public health problem associated with morbidity, mortality and health expenditures and there are various options in its treatment. Left ventricular assist devices are a frequently used treatment alternative to heart transplantation in endstage heart failure. Left ventricular assist devices are used both as a temporary treatment until a suitable donor is found in patients who are waiting for a heart transplant, and as a lifelong treatment when the patient is not suitable for a heart transplant. Although the survival rates are quite high in this treatment option, clinical follow-up and systematic care of patients are critical. Although left ventricular assist devices are a life-saving treatment option, these patients may experience some major complications due to advanced heart failure, open heart surgery technique and implanted device. Major complications seen in these patients are bleeding, cardiac arrhythmias, infections and neurological events. These complications affect quality of life and survival. Therefore, management of complications in the postoperative period becomes the focal point in patients who have implanted left ventricular assist device. Although these complications are not easy to manage, nurses should be equipped with advanced knowledge about the causes, symptoms, and appropriate nursing care of these complications. At the same time, nurses need to know about the technology of left ventricular assist devices for the management of these complications. In this article, major complications seen after left ventricular assist device implantation and nursing care are discussed.

Keywords: Heart-assist devices; nursing care; postoperative complications
ÖZET
e Kalp yetersizliği morbidite, mortalite ve sağlık harcamaları ile ilişkili önemli bir halk sağlığı sorunu olup tedavisinde çeşitli seçenekler bulunmaktadır. Sol ventrikül destek cihazları son evre kalp yetersizliğinde kalp nakline alternatif sık kullanılan bir tedavi seçeneğidir. Sol ventrikül destek cihazları hem kalp nakli bekleyen hastalarda uygun donör bulununcaya kadar geçici bir tedavi olarak hem de hastanın kalp nakli için uygun olmadığı durumlarda ömür boyu sürecek bir tedavi olarak kullanılmaktadır. Bu tedavi seçeneğinde sağ kalım oranları oldukça yüksek olmakla birlikte hastaların klinik takip ve sistematik bakımları kritik önem taşımaktadır. Sol ventrikül destek cihazları hayat kurtarıcı bir tedavi seçeneği olmakla birlikte bu hastalar ileri evre kalp yetersizliği, açık kalp cerrahisi tekniği ve implante edilen cihaz nedeniyle major komplikasyonlar yaşayabilirler. Bu hastalarda görülen major komplikasyonlar kanamalar, kardiyak aritmiler, enfeksiyonlar ve nörolojik olaylardır. Bu komplikasyonlar yaşam kalitesini ve sağ kalımı etkilemektedir. Bu sebeple sol ventrikül destek cihazı implante edilen hastalarda, ameliyat sonrası dönemde komplikasyonların yönetimi odak nokta haline gelmektedir. Bu komplikasyonların yönetimi kolay olmamakla birlikte hemşireler bu komplikasyonların nedenleri, belirtileri ve uygun hemşirelik bakımı hakkında ileri düzeyde bilgi ile donatılmalıdır. Aynı zamanda bu komplikasyonların yönetimi için hemşirelerin sol ventrikül destek cihazlarının teknolojisi hakkında da bilgi sahibi olması gerekmektedir. Bu makalede sol ventrikül destek cihazı implantasyonundan sonra görülen major komplikasyonlar ve hemşirelik bakımı ele alınmaktadır.

Anahtar Kelimeler: Kalp destek cihazları; hemşirelik bakımı; postoperatif komplikasyonlar
REFERENCES:
  1. Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017;3(1):7-11.[Crossref] [PubMed] [PMC] 
  2. Değertekin M, Erol C, Ergene O, Tokgözoğlu L, Aksoy M, Erol MK, et al. [Heart failure prevalence and predictors in Turkey: HAPPY study]. Turk Kardiyol Dern Ars. 2012;40(4):298-308. Turkish.[Crossref] [PubMed] 
  3. Lee CS, Gelow JM, Chien CV, Hiatt SO, Bidwell JT, Denfeld QE, et al. Implant strategy-specific changes in symptoms in response to left ventricular assist devices. J Cardiovasc Nurs. 2018;33(2):144-51.[Crossref] [PubMed] [PMC] 
  4. Gustafsson F, Rogers JG. Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes. Eur J Heart Fail. 2017;19(5):595-602.[Crossref] [PubMed] 
  5. Awad M, Czer LS, De Robertis MA, Mirocha J, Ruzza A, Rafiei M, et al. Adult heart transplantation following ventricular assist device implantation: early and late outcomes. Transplant Proc. 2016;48(1):158-66.[Crossref] [PubMed] 
  6. Vega EA, Enomoto TM. Complications following left ventricular assist device implantation: diagnosis and management of common adverse events. Curr Anesthesiol Rep. 2015;5(4):361-9.[Crossref] 
  7. Strueber M, O'Driscoll G, Jansz P, Khaghani A, Levy WC, Wieselthaler GM; HeartWare Investigators. Multicenter evaluation of an intrapericardial left ventricular assist system. J Am Coll Cardiol. 2011;57(12):1375-82.[Crossref] [PubMed] 
  8. Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, et al; HeartMate II Clinical Investigators. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139(5):1316-24.[Crossref] [PubMed] 
  9. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34(12):1495-504.[Crossref] [PubMed] 
  10. Yılmaz MB, Akar AR, Ekmekçi A, Nalbantgil S, Sade LE, Eren M, et al. [Future of advanced heart failure and mechanical support devices: A Cardiology-Cardiovascular Surgery Consensus Report]. Turk Kardiyol Dern Ars. 2016;44(2):175-88.[Crossref] [PubMed] 
  11. Jezovnik MK, Gregoric ID, Poredos P. Medical complications in patients with LVAD devices. J Cardiol Pract. 2017;14(37).[Link] 
  12. Chmielinski A, Koons B. Nursing care for the patient with a left ventricular assist device. Nursing. 2017;47(5):34-40.[Crossref] [PubMed] 
  13. Sen A, Larson JS, Kashani KB, Libricz SL, Patel BM, Guru PK, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20(1):153.[Crossref] [PubMed] [PMC] 
  14. Hieda M, Sata M, Nakatani T. The importance of the management of infectious complications for patients with left ventricular assist device. Healthcare (Basel). 2015;3(3):750-6.[Crossref] [PubMed] [PMC] 
  15. Barnes K. Complications in patients with ventricular assist devices. Dimens Crit Care Nurs. 2008;27(6):233-41.[Crossref] [PubMed] 
  16. McIlvennan CK, Thompson JS, Matlock DD, Cleveland JC Jr, Dunlay SM, LaRue SJ, et al. A multicenter trial of a shared decision support intervention for patients and their caregivers offered destination therapy for advanced heart failure: DECIDE-LVAD: rationale, design, and pilot data. J Cardiovasc Nurs. 2016;31(6):E8-20.[Crossref] [PubMed] 
  17. Nowotny BH, Boner DH, Maltais S. Ventricular assist device implantation: perioperative nursing considerations. AORN J. 2016;103(4):389-403.[Crossref] [PubMed] 
  18. Grimm JC, Magruder JT, Kemp CD, Shah AS. Late complications following continuous-flow left ventricular assist device implantation. Front Surg. 2015;2:42.[Crossref] [PubMed] [PMC] 
  19. Koval CE, Rakita R; AST Infectious Diseases Community of Practice. Ventricular assist device related infections and solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:348-54.[Crossref] [PubMed] 
  20. Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, et al; HeartMate II Clinical Investigators. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357(9):885-96.[Crossref] [PubMed] 
  21. Kilic A, Acker MA, Atluri P. Dealing with surgical left ventricular assist device complications. J Thorac Dis. 2015;7(12):2158-64.[Crossref] [PubMed] [PMC] 
  22. O'Shea G. Ventricular assist devices: what intensive care unit nurses need to know about postoperative management. AACN Adv Crit Care. 2012;23(1):69-83.[Crossref] [PubMed] 
  23. Bunte MC, Blackstone EH, Thuita L, Fowler J, Joseph L, Ozaki A, et al. Major bleeding during HeartMate II support. J Am Coll Cardiol. 2013;62(23):2188-96.[Crossref] [PubMed] 
  24. Bruckner BA, DiBardino DJ, Ning Q, Adeboygeun A, Mahmoud K, Valdes J, et al. High incidence of thromboembolic events in left ventricular assist device patients treated with recombinant activated factor VII. J Heart Lung Transplant. 2009;28(8):785-90.[Crossref] [PubMed] 
  25. Bracey A, Shander A, Aronson S, Boucher BA, Calcaterra D, Chu MWA, et al. The use of topical hemostatic agents in cardiothoracic surgery. Ann Thorac Surg. 2017;104(1):353-60.[Crossref] [PubMed] 
  26. National Institute for Health and Care Excellence. Implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplantation. 2015. (Date of access: 1.11.2018)[Link] 
  27. Schaffer JM, Arnaoutakis GJ, Allen JG, Weiss ES, Patel ND, Russell SD, et al. Bleeding complications and blood product utilization with left ventricular assist device implantation. Ann Thorac Surg. 2011;91(3):740-7.[Crossref] [PubMed] 
  28. Slaughter MS. Hematologic effects of continuous flow left ventricular assist devices. J Cardiovasc Transl Res. 2010;3(6):618-24.[Crossref] [PubMed] 
  29. Islam S, Cevik C, Madonna R, Frandah W, Islam E, Islam S, et al. Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series. Clin Cardiol. 2013;36(4):190-200.[Crossref] [PubMed] [PMC] 
  30. Gurvits GE, Fradkov E. Bleeding with the artificial heart: gastrointestinal hemorrhage in CF-LVAD patients. World J Gastroenterol. 2017;23(22):3945-53.[Crossref] [PubMed] [PMC] 
  31. Harvey L, Holley CT, John R. Gastrointestinal bleed after left ventricular assist device implantation: incidence, management, and prevention. Ann Cardiothorac Surg. 2014;3(5):475-9.[Crossref] [PubMed] [PMC] 
  32. Newsom LC, Paciullo CA. Coagulation and complications of left ventricular assist device therapy: a primer for emergency nurses. Adv Emerg Nurs J. 2013;35(4):293-300.[Crossref] [PubMed] 
  33. Allen SJ, Sidebotham D. Postoperative care and complications after ventricular assist device implantation. Best Pract Res Clin Anaesthesiol. 2012;26(2):231-46.[Crossref] [PubMed] 
  34. Uriel N, Pak SW, Jorde UP, Jude B, Susen S, Vincentelli A, et al. Acquired von Willebrand syndrome after continuous-flow mechanical device support contributes to a high prevalence of bleeding during long-term support and at the time of transplantation. J Am Coll Cardiol. 2010;56(15):1207-13.[Crossref] [PubMed] 
  35. Klovaite J, Gustafsson F, Mortensen SA, Sander K, Nielsen LB. Severely impaired von Willebrand factor-dependent platelet aggregation in patients with a continuous-flow left ventricular assist device (HeartMate II). J Am Coll Cardiol. 2009;53(23):2162-7.[Crossref] [PubMed] 
  36. Demirozu ZT, Radovancevic R, Hochman LF, Gregoric ID, Letsou GV, Kar B, et al. Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2011;30(8):849-53.[Crossref] [PubMed] 
  37. Smith EM, Franzwa J. Chronic outpatient management of patients with a left ventricular assist device. J Thorac Dis. 2015;7(12):2112-24.[Crossref] [PubMed] [PMC] 
  38. Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al; International Society for Heart and Lung Transplantation. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32(2):157-87.[Crossref] [PubMed] 
  39. Aggarwal A, Pant R, Kumar S, Sharma P, Gallagher C, Tatooles AJ, et al. Incidence and management of gastrointestinal bleeding with continuous flow assist devices. Ann Thorac Surg. 2012;93(5):1534-40.[Crossref] [PubMed] 
  40. Marsano J, Desai J, Chang S, Chau M, Pochapin M, Gurvits GE. Characteristics of gastrointestinal bleeding after placement of continuous-flow left ventricular assist device: a case series. Dig Dis Sci. 2015;60(6):1859-67.[Crossref] [PubMed] 
  41. Goldstein DJ, Beauford RB. Left ventricular assist devices and bleeding: adding insult to injury. Ann Thorac Surg. 2003;75(6 Suppl):S42-7.[Crossref] [PubMed] 
  42. Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, et al; HeartMate II Clinical Investigators. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010;29(4 Suppl):S1-39.[Crossref] [PubMed] 
  43. Vandse R, Papadimos TJ. Successful perioperative management of a patient with the left ventricular assist device for brain tumor resection: case report and review of the literature. Case Rep Anesthesiol. 2015;2015:839854.[Crossref] [PubMed] [PMC] 
  44. Castagna F, Stöhr EJ, Pinsino A, Cockcroft JR, Willey J, Reshad Garan A, et al. The unique blood pressures and pulsatility of LVAD patients: current challenges and future opportunities. Curr Hypertens Rep. 2017;19(10):85.[Crossref] [PubMed] [PMC] 
  45. Willey JZ, Boehme AK, Castagna F, Yuzefpolskaya M, Garan AR, Topkara V, et al. Hypertension and stroke in patients with Left Ventricular Assist Devices (LVADs). Curr Hypertens Rep. 2016;18(2):12.[Crossref] [PubMed] [PMC] 
  46. Pratt AK, Shah NS, Boyce SW. Left ventricular assist device management in the ICU. Crit Care Med. 2014;42(1):158-68.[Crossref] [PubMed] 
  47. Bennett MK, Adatya S. Blood pressure management in mechanical circulatory support. J Thorac Dis. 2015;7(12):2125-8.[Crossref] [PubMed] [PMC] 
  48. Rangasamy S, Madan S, Saeed O, Goldstein DJ, Jorde UP, Negassa A, et al. Noninvasive measures of pulsatility and blood pressure during continuous-flow left ventricular assist device support. ASAIO J. 2019;65(3):241-6.[Crossref] [PubMed] 
  49. Brisco MA, Sundareswaran KS, Milano CA, Feldman D, Testani JM, Ewald GA, et al; HeartMate II Clinical Investigators. Incidence, risk, and consequences of atrial arrhythmias in patients with continuous-flow left ventricular assist devices. J Card Surg. 2014;29(4):572-80.[Crossref] [PubMed] 
  50. Kadado AJ, Akar JG, Hummel JP. Arrhythmias after left ventricular assist device implantation: incidence and management. Trends Cardiovasc Med. 2018;28(1):41-50.[Crossref] [PubMed] 
  51. Mulloy DP, Mahapatra S, Kern JA. Treatment of ventricular arrhythmias in patients undergoing LVAD therapy. In: Shuhaiber J, ed. Ventricular Assist Devices. In Tech; 2011.[Crossref] 
  52. Boyle A. Arrhythmias in patients with ventricular assist devices. Curr Opin Cardiol. 2012;27(1):13-8.[Crossref] [PubMed] 
  53. Ziv O, Dizon J, Thosani A, Naka Y, Magnano AR, Garan H. Effects of left ventricular assist device therapy on ventricular arrhythmias. J Am Coll Cardiol. 2005;45(9):1428-34.[Crossref] [PubMed] 
  54. Mudge GH Jr, Fang JC, Smith C, Couper G. The physiologic basis for the management of ventricular assist devices. Clin Cardiol. 2006;29(7):285-9.[Crossref] [PubMed] [PMC] 
  55. Potapov EV, Stepanenko A, Krabatsch T, Hetzer R. Managing long-term complications of left ventricular assist device therapy. Curr Opin Cardiol. 2011;26(3):237-44.[Crossref] [PubMed] 
  56. Kirklin JK, Naftel DC, Kormos RL, Pagani FD, Myers SL, Stevenson LW, et al. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2014;33(1):12-22.[Crossref] [PubMed] 
  57. Sharma V, Deo SV, Stulak JM, Durham LA 3rd, Daly RC, Park SJ, et al. Driveline infections in left ventricular assist devices: implications for destination therapy. Ann Thorac Surg. 2012;94(5):1381-6.[Crossref] [PubMed] 
  58. Hannan MM, Husain S, Mattner F, Danziger-Isakov L, Drew RJ, Corey GR, et al; International Society for Heart and Lung Transplantation. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transplant. 2011;30(4):375-84.[Crossref] [PubMed] 
  59. Topkara VK, Kondareddy S, Malik F, Wang IW, Mann DL, Ewald GA, et al. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg. 2010;90(4):1270-7.[Crossref] [PubMed] 
  60. John R, Aaronson KD, Pae WE, Acker MA, Hathaway DR, Najarian KB, et al; HeartWare Bridge to Transplant ADVANCE Trial Investigators. Drive-line infections and sepsis in patients receiving the HVAD system as a left ventricular assist device. J Heart Lung Transplant. 2014;33(10):1066-73.[Crossref] [PubMed] 
  61. Pauwaa S, Bhat G. Ventricular assist device-specific infections. In: Shuhaiber J, ed. Ventricular Assist Devices. In Tech; 2011.[Crossref] [PMC] 
  62. Balsam LB, Jacoby A, Louie E, Levine JP. Long-term success with driveline exit site relocation for deep driveline infection in left ventricular assist device patients. Innovations (Phila). 2017;12(6):440-5.[Crossref] [PubMed] 
  63. Son AY, Stein LH, Reyentovich A, Katz SD, Smith DE, DeAnda A, et al. Increased driveline infection with betadine antisepsis: considerations for chlorhexidine intolerant patients. J Heart Lung Transplant. 2016;35(4):256.[Crossref] 
  64. Hernandez GA, Breton JDN, Chaparro SV. Driveline infection in ventricular assist devices and its implication in the present era of destination therapy. Open J Cardiovasc Surg. 2017;9:1179065217714216.[Crossref] [PubMed] [PMC] 
  65. Lander MM, Kunz N, Dunn E, Althouse AD, Lockard K, Shullo MA, et al. Substantial reduction in driveline infection rates with the modification of driveline dressing protocol. J Card Fail. 2018;24(11):746-52.[Crossref] [PubMed] 
  66. Leuck AM. Left ventricular assist device driveline infections: recent advances and future goals. J Thorac Dis. 2015;7(12):2151-7.[Crossref] [PubMed] [PMC] 
  67. Trachtenberg BH, Cordero-Reyes A, Elias B, Loebe M. A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management. Methodist Debakey Cardiovasc J. 2015;11(1):28-32.[Crossref] [PubMed] [PMC] 
  68. Cannon A, Elliott T, Ballew C, Cavey J, O'Shea G, Franzwa J, et al. Variability in infection control measures for the percutaneous lead among programs implanting long-term ventricular assist devices in the United States. Prog Transplant. 2012;22(4):351-9.[Crossref] [PubMed] 
  69. Menon AK, Baranski SK, Unterkofler J, Autschbach R, Moza AK, Goetzenich A, et al. Special treatment and wound care of the driveline exit site after left ventricular assist device implantation. Thorac Cardiovasc Surg. 2015;63(8):670-4.[Crossref] [PubMed] 
  70. Martin BJ, Luc JGY, Maruyama M, MacArthur R, Bates AR, Buchholz H, et al. Driveline site is not a predictor of infection after ventricular assist device implantation. ASAIO J. 2018;64(5):616-22.[Crossref] [PubMed] 
  71. Wus L, Manning M, Entwistle JW 3rd. Left ventricular assist device driveline infection and the frequency of dressing change in hospitalized patients. Heart Lung. 2015;44(3):225-9.[Crossref] [PubMed] 
  72. Iseler J, Hadzic KG. Developing a kit and video to standardize changes of left ventricular assist device dressings. Prog Transplant. 2015;25(3):224-9.[Crossref] [PubMed] 
  73. Slaughter MS, Pagani FD, McGee EC, Birks EJ, Cotts WG, Gregoric I, et al; HeartWare Bridge to Transplant ADVANCE Trial Investigators. HeartWare ventricular assist system for bridge to transplant: combined results of the bridge to transplant and continued access protocol trial. J Heart Lung Transplant. 2013;32(7):675-83.[Crossref] [PubMed] 
  74. Teuteberg JJ, Slaughter MS, Rogers JG, McGee EC, Pagani FD, Gordon R, et al; ADVANCE Trial Investigators. The HVAD left ventricular assist device: risk factors for neurological events and risk mitigation strategies. JACC Heart Fail. 2015;3(10):818-28.[Crossref] [PubMed] 
  75. Willey JZ, Gavalas MV, Trinh PN, Yuzefpolskaya M, Reshad Garan A, Levin AP, et al. Outcomes after stroke complicating left ventricular assist device. J Heart Lung Transplant. 2016;35(8):1003-9.[Crossref] [PubMed] [PMC] 
  76. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.[Crossref] [PubMed] 
  77. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, et al; MERCI Trial Investigators. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke. 2005;36(7):1432-8.[Crossref] [PubMed] 

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4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com