[jamonit]

I was wondering if you all have VAD patients at your facilities. I work on a progressive cardiac care floor with several pt's that have VADs and artificial hearts (the Jarvik). Anyway, I have been a heart transplant nurse for a year now and will be taking classes through the hospital for VAD certification. I was wondering if anyone has any tips or pointers for taking care of this unique population of patients.

[CVICURN2003]

Originally Posted by jamonit

I was wondering if you all have VAD patients at your facilities. I work on a progressive cardiac care floor with several pt's that have VADs and artificial hearts (the Jarvik). Anyway, I have been a heart transplant nurse for a year now and will be taking classes through the hospital for VAD certification. I was wondering if anyone has any tips or pointers for taking care of this unique population of patients.

WOW! I did not know Jarvik had FDA approval. Maybe you are at a research hospital. We use ABIOMED blood pumps and ventricles. Two tips....running shoes and a flashlight (to look for clots)

[SEOBowhntr]

Originally Posted by CVICURN2003

WOW! I did not know Jarvik had FDA approval. Maybe you are at a research hospital. We use ABIOMED blood pumps and ventricles. Two tips....running shoes and a flashlight (to look for clots)

Um, he has for years, do a little research.....

http://www.jarvikheart.com/home.asp

Not meant to be "smart," just honest.

Also a good read on why he's a LIPITOR spokesman.

[Asechikan]

Originally Posted by jamonit

I was wondering if you all have VAD patients at your facilities. I work on a progressive cardiac care floor with several pt's that have VADs and artificial hearts (the Jarvik). Anyway, I have been a heart transplant nurse for a year now and will be taking classes through the hospital for VAD certification. I was wondering if anyone has any tips or pointers for taking care of this unique population of patients.

I work on CCU and we have lots of VAD's. I have experience with the Jarvik, Thoratec, Heartmate, and Debakey VADs. In my experiece these people are are a very challenging group of patients to care for for a number of reasons. We VAD a lot of very sick people so ultimatly I have seen alot of very poor outcomes, very few success stories. However when used for a short time as a bridge to transplant it is very rewarding to see these people do well.

You will get very attached to these patients and their faimilies b/c of the level of care and involvement that is needed between them and the nurse. You will spend alot of time with these people and they will be in the hospital for a very long time. You can not stress enough the proper compliance in their care. Three things typically cause these patients to die, infection, head bleed, or blood clot. Because of this the longer they have the VAD the more likley one of those complications is to occur. Your biggest tool is to educate these people not only in their care but in coming to terms with end of life as well should they not get a heart.

As for specific tips for their care, each VAD, and each patients needs are different. They all have specific dressing changes, Code procedures, flow ranges etc.. its best to simply be familiar with each type you have and how to identify potential complications as they develope so you can head off the problem before it becomes critical. I hope this helps some, if you have more specific questions let me know. good luck.

[ghillbert]

Jarvik approval? Depends on the device. The Jarvik 2000 is still used in clinical trial, although not approved by the FDA yet. It is approved in Europe (CE Mark). The old Jarvik 7 total art heart (then CardioWest, now Syncardia) is approved for BTT use.

Most important nursing considerations:
- Fluid status: most devices, both pulsatile and continuous flow, are highly dependent on preload and most flow problems are solved by increasing fluid administration (most commonly making pts drink more!).
- Blood pressure control: Hypertension makes the VAD have to work harder to eject blood, which can also reduce the VAD's mechanical life (esp say the Heartmate I XVE).
- Infection control: you cannot be TOO vigilant with these patients' infection control. Strict sterile dressings by trained staff, masks on pt and staff, close monitoring of driveline exit sites.
- Good technical support from your perfusion/clinical engineering departments: especially if you see the devices infrequently, you need retraining.

Any specific questions, let me know.

[divacath08]

We use the Heartmate mostly at our facility, but as a bridge to transplant we use the tandem heart procedure. Good and bad results with that!! But we do have an amazing transplant number with these sick folks!!

[ghillbert]

Unusual to use TandemHeart as a bridge to transplant - it's generally used as a very short term, rescue-type therapy for acute cardiogenic shock or high-risk coronary interventions.