LVAD and Cardiac rehab

  1. 0 Does anyone work Cardiac rehab and take LVAD patients at your setting? Do you have any special policies regarding these patients? Especially regarding Heart Mate II?????
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  3. Visit  lee1 profile page

    About lee1

    Joined Jan '99; Posts: 716; Likes: 179.

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    15 Comments so far...

  4. Visit  ghillbert profile page
    0
    Answered your other post. I work with VADs and send many to rehab either inpatient prior to discharge or in the community.

    Main things:
    - manual BPs using portable doppler required (can't use automated BP)
    - maintain blood volume (answer to most problems is to drink more)
    - any problems with dizziness etc, get them to lay down and elevate feet
    - make sure you have their backup equipment (controller, power supplies) and know how to switch controllers in emergency (or that they do)
    - protect their driveline exit site - make sure pt is wearing abdominal binder and immobilizing their lead.
  5. Visit  lee1 profile page
    0
    Thanks for the info, have you ever seen any problems personally?
  6. Visit  ghillbert profile page
    0
    I've seen lots of problems personally, but I work in a VAD program

    What I listed above are the most common rehab issues, particularly dizziness/low flows.

    Another possibility with continuous flow pumps like HM-II is SOB, which may indicate the pump speed needs to be increased to account for the excess activity once patient gets more mobile. If you have lowish pump outputs (<4) and SOB, pump speed is very likely too low, and this must be fixed by VAD team.
  7. Visit  lee1 profile page
    0
    So far, this patient has only come in for 4 visits. He has underlying COPD but is listed status 1B. He wears O2 while he is exercising only. Hopefully his COPD will clear up more before TX. He does have some SOB generally after the last exercise but it resolves as soon as he rests a minute and his pulse ox comes up. We are not pulmonary rehab, so not used to dealing with this aspect. I do encourage him to drink water if he feels thirsty.
    Do you have any guidelines or policies for this type of patient at phase II cardiac rehab???
    I have been making something up but always nice to see others.

    Lee RN
  8. Visit  ghillbert profile page
    0
    Unfortunately the VAD can't help his COPD, although it can help reduce PA pressures over time with better offloading. Make sure he tells his VAD team when he goes to clinic that he is getting SOB with exercise - he may need pump speed increased if he has a high PI, but you won't be able to tell without hooking him to monitor.

    We do have a protocol, I'm having it sent to me and will forward. Are you looking for pump related issues or what type of exercises etc? I can ask our PTs if they have anything also.
  9. Visit  lee1 profile page
    0
    Quote from ghillbert
    Unfortunately the VAD can't help his COPD, although it can help reduce PA pressures over time with better offloading. Make sure he tells his VAD team when he goes to clinic that he is getting SOB with exercise - he may need pump speed increased if he has a high PI, but you won't be able to tell without hooking him to monitor.

    We do have a protocol, I'm having it sent to me and will forward. Are you looking for pump related issues or what type of exercises etc? I can ask our PTs if they have anything also.
    Thanks again for the info, we are watching him carefully, at this point he only needs to use the O2 when he is exercising. He is listed 1B, but then he is type O, which puts him further down on the list. If you have any protocol please send to me. Would really appreciate it.

    Lee
    Last edit by dianah on Nov 14, '09 : Reason: Removed email, as posting email is Terms of Service violation
  10. Visit  dianah profile page
    0
    note from staff:

    to communicate, members may use the pm system or email. both are accessed by clicking on the appropriate icon below each member's name. if the icons are not visible, click once on the member's name and they should appear.
    thank you.
  11. Visit  ghillbert profile page
    0
    ??? What's that for?
  12. Visit  cardiac rehab rn profile page
    0
    We are admitting a pt with an LVAD (first one) next week. Can you send me your protocol please?

    albell1@carilionclinic.org
  13. Visit  skkrrt profile page
    0
    We also are admitting our first LVAD patient and would like to ask for protocol / care / emergency information please.
    bwsk.85@gmail.com
  14. Visit  ghillbert profile page
    0
    Go to Thoratec - Innovative Therapies for Advanced Heart Failure
    for manuals, presentations, academic papers and guidelines about the Heartmate II pump.
  15. Visit  Jayne Goldberg profile page
    0
    I've also been looking for protocols for LVAD pts in Cardiac Rehab. I saw your post and wondered if you would be willing to forward your protocol to me as well since we will soon see our first patient. What you wrote originally was very helpful and we would appreciate any other information you have. Thanks


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