Re: Patients with VADs discharge question
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Just noticed this topic!
Discharge criteria depend on the device - particularly pulsatile or non-pulsatile devices.
Usually:
- Pts & family carers receive 3-4 training sessions and take a written test (emergency procedures, care of the wound, drivelines, drivers, controller changes etc).
- Driving is not advised with non-pulsatile devices. Pts with pulsatile devices can have a weaning study where we turn the pump down to check what native function they have left in reserve (and if they'd be ok on the road if the pump stopped). If they have some function left, they can be approved to drive. Generally not advised, although some patients do it anyway.
- Home care nurses tend to go once per week to do the dressings and INR blood draws. INR (depending on device) usually aiming for around 2.5.
- Pts can shower but not bathe - and showering is not permitted until the driveline has complete healing. At my hospital, we don't recommend showering anyhow, if they have to they need to cover all the exit site with saran wrap and cover all device components with the shower kit. If it's a Heartmate I, they need to add the extender to the filter socket.
- Usually need a family caregiver around who is trained in the device emergency procedures. IF the patient has a VF or VF underlying rhythm, the carer must be present 24/7.
- Pt always has to carry the primary driver/controller as well as a spare backup driver/controller, AC adaptor/s,
spare batteries, handpumps (if using Heartmate I or Thoratec).
- We do not discharge Abiomed AB5000 patients.
- Pt does daily weight, BP and temperature. and must notify artificial heart with any significant changes.
Anything else, let me know.
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