LVADS in the community

KeepItRealRN, BSN, RN · Apr 21, 2011

By the time the patient is in the outpatient setting the VAD is pretty much on auto pilot. To keep this simple, the worst error that one could make is to make the patient "too dry" intravascularly as then the VAD could completely empty the left ventricle and cause a "suck down" event.

allnurses Guide · Apr 23, 2011

you do what you accept to do. My opinion only. They belong in a dialysis center within a hospital setting. An arrest is an arrest and the poor Renal RN taking care of the pt. is accepting the responsibility. Family member/caregiver or not the RN is ultimately going to be accountable. We all know that some family members are ready to sue in a heart beat. Even if that heart beat is only 10% EF and is knocking on gates.

Do you work with VADs? I ask because there is no reason recipients need to be in a hospital dialysis setting. We have VAD patients doing RV trips around the country and going on cruises... why on earth couldn't they attend outpt dialysis? If "an arrest is an arrest" then there shouldn't be any outpt dialysis centers by your logic, in case the "poor renal RN taking care of the patient" is held responsible for any patient arresting. It's like saying someone with a pacemaker or ICD or transplanted heart shouldn't go to outpt dialysis, which is frankly ridiculous also. In fact, someone with an LVAD is a lot better off in an arrest situation than Joe Schmoe without one... because it's going to keep on working.

pawashrn · Apr 23, 2011

ghilbert. point well taken. But a renal nurse and a CV nurse are two different skills and knowledge. As, in the comment before yours. If the Dialysis Nurse makes the pt. intravasculary dry then their actions are directly responsible for the pt's. pre-arrest condition. I am just saying that, once you have an LVAD and need dialysis a hospital setting with readily available knowledgeable support is the best setting for this pt. Not in a dialysis unit where the only support is another Dialysis RN and the local EMS. Taking roadtrips and traveling is the responsibility of the patient and is not involving another person's livelyhood in this decision. The dialysis RN is doing a job, period. Their life is going home and taking care of their families. It is not a calling, nursing is job, that only a few people can do and do well. It is no different than the master carpenter. Just because we may save a life or partake in the healing of another person. We should not place our egos on such a pedestal that we feel that we are better than the average person. A garbage man's job decreases mass infection among the populace by removing waste from our immediate enviroment, therefore, allowing all of us live a healthier life. Enjoy and nice hearing from you.

allnurses Guide · Apr 24, 2011

Honestly I am not at all sure what you're going on about re garbagemen or carpenters. I made no mention of nursing being "a calling".

The renal RN's "livelyhood" is not at stake, in that almost all LVAD patients sign to say that they and their caregiver are responsible for the device and not the dialysis center.

Trauma Columnist · Apr 24, 2011

Ghilbert. Where are these caregivers? Dialysis units are not a place where we have room for extra people.

CardioTrans, BSN, RN · May 5, 2011

People who have VADs placed are very well educated in taking care of the VAD before they leave the hospital. As for the patient becoming "dry"... the VAD will alarm if the perfusion or volume is low before they are to the point of passing out.

Our VAD coordinators, like ghillbert mentioned, are very willing to do education classes if a patient will be going to outpt dialysis. Pts with VADs live very active lives, much like a person with a healthy heart. One of the main concerns for these patients are risks of infection at the drive line site..... not the pump itself. Our pts are also instructed that they must/need to have a trained family member with them at all times..... The EMS that will be called in case something happens are also taught how to take care of the patient and know how to handle the VAD.

Biffbradford · May 5, 2011

FWIW, A friend of mine is a very experienced EMT and when I asked him about LVADs, he had to Google that term to find out what it meant. I agree, however, that LVAD patients should be able to go to out patient dialysis. No, the dialysis nurses aren't CV trained, but they don't have to be, after working with their patients three times per week, those nurses know them inside and out. Like already stated, that LVAD is going to keep on pumping no matter what. You can't say that for the other 99.9% of the patients in there.

GreyGull · May 6, 2011

FWIW, A friend of mine is a very experienced EMT and when I asked him about LVADs, he had to Google that term to find out what it meant.

In fairness to the EMT, LVADs are not covered nor is there enough Anatomy or Physiology taught in the EMT class to barely cover what an MI is. Even Paramedics usually do not get LVADs mentioned in their class. Hopefully once they hear the term they will seek out more education about them. Usually the patient or caregiver will provide whatever information is needed for transport. In my area if it is an interfacility transport, RNs work on the CCT with the EMTs to do the driving and help move the patient. At least the EMTs working these trucks should have some info about them depending on how involved they want to be with the patient.

highlandlass1592, BSN, RN · May 6, 2011

In fairness to the EMT, LVADs are not covered nor is there enough Anatomy or Physiology taught in the EMT class to barely cover what an MI is. Even Paramedics usually do not get LVADs mentioned in their class. Hopefully once they hear the term they will seek out more education about them. Usually the patient or caregiver will provide whatever information is needed for transport. In my area if it is an interfacility transport, RNs work on the CCT with the EMTs to do the driving and help move the patient. At least the EMTs working these trucks should have some info about them depending on how involved they want to be with the patient.

Our VAD center offers training to first responders in the area where a VAD patient lives. They go and teach classes discussing VAD's, how to troubleshoot problems, quite a bit of information. I know this first hand as a friend of mine who is a VAD coordinator actually went to inservice the EMT's of a small town where one of our patients lived. The town was 5 hours away. She coordinated the class, drove up, spent 2 days inservicing everyone then drove home the following day.

I do agree that LVAD's aren't taught to EMT's as a part of regular coursework. But to say ALL EMT's aren't taught LVAD's, just isn't true. I am not sure if ALL LVAD centers do this but I know mine does. And, just as an aside, they teaching first responders get about VAD's is way better than I got when I first started dealing with them. The VAD coordinators where I work have put together a great education package.

Biffbradford · May 6, 2011

[color=silver]our vad center offers training to first responders in the area where a vad patient lives. they go and teach classes discussing vad's, how to troubleshoot problems, quite a bit of information. i know this first hand as a friend of mine who is a vad coordinator actually went to inservice the emt's of a small town where one of our patients lived. the town was 5 hours away. she coordinated the class, drove up, spent 2 days inservicing everyone then drove home the following day.
i do agree that lvad's aren't taught to emt's as a part of regular coursework. but to say all emt's aren't taught lvad's, just isn't true. [color=silver]i am not sure if all lvad centers do this but i know mine does. and, just as an aside, they teaching first responders get about vad's is way better than i got when i first started dealing with them. the vad coordinators where i work have put together a great education package.

careful. it was inferred earlier that all emts are trained on vads. i mentioned one, a friend of mine that was not. clearly some emts are, some aren't, just like rns or mds for that matter. :uhoh3:

GreyGull · May 6, 2011

I do agree that LVAD's aren't taught to EMT's as a part of regular coursework. But to say ALL EMT's aren't taught LVAD's, just isn't true.

I don't think any one stated "ALL". But it is unfair to expect an EMT especially at the Basic or Intermediate level to have knowledge of these devices or even the pathology behind the disease process. The 110 - 120 hour EMT course is barely enough time for them to master CPR, first aid and emergency driving. They need to get the basics down and hopefully will have an employer who will see they get more training as it becomes available or necessary. Right now in one county we have over 2000 firefighters who are Paramedics. It is very difficult to get everyone the necessary training for everything. They just started doing 12 - lead ECGs a couple of years ago and it has been a slow process even with machine interpretation and transmitting to the hospital. There are still many counties which do not do 12 - leads. So, it is unfair to assume everyone in EMS is as advanced as your area also. I think just like any other health care professional, there is just not enough time in the day to learn all about everything new even though we'd like to nor can we expect someone to be procificient in every detail if it is something they don't see daily.

CardioTrans, BSN, RN · May 7, 2011

I was the one who mentioned EMS being trained for the VAD patients.... but what I said was the EMS that would respond to the pt with a VAD would be trained. As Highlandlass stated, our VAD coordinators do go into the community where the pts live and teach the EMS how to take care of the VAD.... I agree that not all EMTs are taught how to take care of them.