Bivad

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I was curious to collect feedback from nurses who have experience with bivad patients about their outcomes, recovery, etc...

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This thread is a bit old, but no one answered your questions, so I hope my own two cents is ok.

I work on a heart transplant unit. we have 4-6 thorotec's to bivads on your average day. Our purpose is not for those cabg pt.s who can't get off pump and can be weaned off the vad, but long term bridge to transplantation.

The problem is not how long patients will tolerate the vad, but how long before a heart comes. long pause. this is the end all and be all of it.

Once stabalized post surgery, they enter a very long waiting period. It takes months to train them ho to care for it, switch to battery, do the dressing changes from the abdominal drive lines. Physical therapy if they've been sick long. Then prepare them to go home, yup, with the device. This can take one to three months, assuming no complications

The most pressing nurse/patient issues are psychiatric, waiting, waiting, is heart breaking, they spend months, longest inpatient I've seen is 9 months, longest outpatient is 16 months, (his failed, didn't qualify for a heart, long political story, we replaced it and he's dying of DIC). Then you have nutrition, those darned devices increase your metabolic demand so high that duotubes are common, which makes sending them home so much harder. And then you have your strokes, yep.

I have wittnessed many successful lvad's to transplantation, we sent "bob" back to the stepdown 5 days after transplantation, he had spent 5 months on a lvad. "bob was our 33rd heart transplant, he walks the halls now, doing great.

We have 5 patients in outlying communities with lvads at home. Problem is that after 30 days from surgery, no inotropes they are bumped down the list, so the new lvads are listed as 1A as well as those on multiple inotropes.

sorrry so long and late, but it is a miracle to me, these patients have become family because they are with us for up to a year, and frequent flyers after that, but our successes are just BEAUTIFUL, if not often enough due to lack of donors.

feel free to pm me with any questions

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What "Heart queen " said...that's what I'm thinking. ;)

The bridge to transplant have more positive outcomes than those who we have been having trouble getting off pump. Although I have seen 2 people out of maybe 10 survive. At My hospital, the Perfusionist(pump team) is there 24/7 with these patients, with a RN 1:1. Many times these patients also have their chest still open from the OR which means "wash outs" dressing changes.

Bleeding is a major issue.

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Thanks for your replies!

We're on our second bivad patient. They have both been bridge to transplant. They both suffered respiratory issues. The first one died after greater than 30 days. The second one, is still being ventilated after greater than 30 days, which keeps her on the hold list.

We've all watched the Thoratec education videos and at the end, they show the patients ambulating down the halls and doing butterfly excercises, treadmills, excercise bikes, etc.... We were just wondering if our experience is typical of if most of these patients do well enough to eventually make it home with the portable drive. So far, our experience has been somewhat heartbreaking.

Thanks for the responses, and keep some heartfelt wishes for "Chloe".... she needs them. :)

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yes, to what you have seen, the good.. patients walking down the halls, and the bad, like you have now. we also have that mix inbetween, that just keep getting complications after you've just made it through the last crisis. We now have three vads on the unit. two are ambulatory, knock on wood, with out major complications, one had surgery, and is very sick.

hey, one of my 1A patients got a heart this past monday and is walking around, "pump head" cleared in a few days. so day 5, she's walking, talking, doing great.... seeing this, is what makes it soooo worth while.

keep at it, there are great success stories.

Thanks for your replies!

We're on our second bivad patient. They have both been bridge to transplant. They both suffered respiratory issues. The first one died after greater than 30 days. The second one, is still being ventilated after greater than 30 days, which keeps her on the hold list.

We've all watched the Thoratec education videos and at the end, they show the patients ambulating down the halls and doing butterfly excercises, treadmills, excercise bikes, etc.... We were just wondering if our experience is typical of if most of these patients do well enough to eventually make it home with the portable drive. So far, our experience has been somewhat heartbreaking.

Thanks for the responses, and keep some heartfelt wishes for "Chloe".... she needs them. :)

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yes, to what you have seen, the good.. patients walking down the halls, and the bad, like you have now. we also have that mix inbetween, that just keep getting complications after you've just made it through the last crisis. We now have three vads on the unit. two are ambulatory, knock on wood, with out major complications, one had surgery, and is very sick.

hey, one of my 1A patients got a heart this past monday and is walking around, "pump head" cleared in a few days. so day 5, she's walking, talking, doing great.... seeing this, is what makes it soooo worth while.

keep at it, there are great success stories.

Thanks for your replies!

We're on our second bivad patient. They have both been bridge to transplant. They both suffered respiratory issues. The first one died after greater than 30 days. The second one, is still being ventilated after greater than 30 days, which keeps her on the hold list.

We've all watched the Thoratec education videos and at the end, they show the patients ambulating down the halls and doing butterfly excercises, treadmills, excercise bikes, etc.... We were just wondering if our experience is typical of if most of these patients do well enough to eventually make it home with the portable drive. So far, our experience has been somewhat heartbreaking.

Thanks for the responses, and keep some heartfelt wishes for "Chloe".... she needs them. :)

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I think outcome depends largely on the reason for implantation.

Senario 1-Pt has heart failure but is mostly stable with some inotropes. LVAD/BiVad placed BEFORE pt decompensates emergently for bridge to transplant. Outcome in this case is generally better.

Senario 2-Pt has open heart surgery AVR/MVR/CABG or whatever. Pt is on pump and for some known or unknown reason, they have difficult time getting patient off the pump. IABP placed. Pt still cannot get off pump. LVAD placed. Pt can get off pump but the right side is not pumping well. RVAD placed. Send to unit with (dare I say it...ABIOMED Bivad for bridge to recovery). Total pump time greater than 5 hours. This patient is highly unlikely to recover but thanks to modern technology will bleed, bleed, bleed, and turn into the staypuffed marshmallow man before we finally withdraw(yes, a little inappropriate sarcasm there).

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Specializes in Critical Care Baby!!!!!.

Rshore,

This has been my experience as well. A BIG majority of the LVAD/BIVAD patients we have done have not been planned. These patients do horribly. They bleed, and bleed, and bleed, and get an unheard amount of blood products, several return trips to the OR, and extubated and reintubated several times, sometimes even trached. It is a horrible existence!

The ones that are planned do a little better, however they suffer great depression and lack of motivation. I know that I couldn't live with something ticking away inside me all the time! :o As someone mentioned before, I have seen some of these patients walk the halls, workout on a treadmill, go home with the portable device, etc.... Only 4 patients have lived long enough to get a transplant.

The other flipside of this is ethical. These patients can live a VERY long time with the device. When things turn sour,the family suffers and the doctors won't let go. It is sad and is something that I try and avoid. I don't like caring for these patients, the ethical issues are hard to deal with, the patients themselves are great. I think that there should be a better way though. These patients that are planned LVADs should have months of psych counseling BEFORE the procedure. It is such a life-changing process and hospitalization is LOOOOONNNGGGG!!!!!!

Tracey

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In my limited 6 months of transplant (many CVICU years) I do have one success story of a failure to wean off pump to a BIVAD, post trach and slow wean, he now is ambulating around and just went for a day pass home. Wife and pt. already trained in device and care. We'll send them home soon to rehab and get stronger for transplant. Currently 1b, due to vad being greater than 30 days, a true success story to all the team and CVICU nurses.

As everyone stated it's so sad but true, these emergents can be a mess, our mortality rate is depressing with these guys.

But you know what, when I worked a pure CVICU, I judged these docs as crazy for not just letting them "go" and putting in abio's when the EF was 10% going into the OR. I would think "I'd rather be dead". But seeing the successes, unfortunately not enough of them MIGHT change my mind. Right now a few "puff a lumps" are holding my decision making, one more open chest in the unit after 3 plus surgery's will start me on the ethical rampage.

I'll give ya all a heads up first. Thanks for listening

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our transplants all have to be cleared by the entire team which includes psyc. who follows them, gives an ear and antidepressants. plus we have a support group which meets every two weeks with patients 10 yrs. out to one week out and all those waiting. But the majority of psyc. interactions is done by bedside nurses as I know which ones to print dirty jokes from the web, which ones like puzzles, link up card players and so on. You're right on the bulls eye. It' not enough, but I don't think that we can ever take that fear and anxiety away, no matter what we do. plus, when we're busy with the sick ones, these guys get shafted. I know they understand, they say so, and can hear what's going on, but it's still not right. you are right on the mark mentioning the ethical mess surrounding these folks.

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Oops, I totally forgot about this thread I started! :)

I want to thank you all for your replies. I think we were just starting to get down because both of our bivad patients (they were both planned for... so they weren't unplanned emergent placements) hadn't done well.

The second one finally transferred off our unit to the interventional unit and is doing quite well. Waiting on her trach site to heal so they can put her back to 1A on the transplant list.

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Dear colleagues,

My name is Kurt De Maeyer and I'm a head nurse in a cardiochirurgic icu in a universital hospital in Belgium. Since a few months we have a serious increas of bivads (Excor, Berlin Heart)in our service (4 out of 7 patients). Since my staffing isn't really made for 'coping' with such patients and a yearly budget meeting with the hospital top is planned in september, I'm looking for information on nursing-patient staff ratio's with such patients. Do you have scientific literature about the nursing-patient staff ratio's in settings with Bivad's or are you willing to inform me about those ratio's in your service ?

Thank you very much,

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