Heartmate II

[tobagosama]

Hello,

I'm very new to caring for LVAD patients and am still trying to wrap my head around some of the basics. I was hoping someone might help clarify a few of them for me.

I had a patient the other night who at change of shift increased his flows & power while his PI remained stable. The flows had been about 5.4 - 5.9 overnight and he bumped up to 6.5 - 7. The PI remained unchanged. Not a huge change, but it took him outside of the ordered parameters. I was just wondering if someone could break down potential causes of increased power for me and what it can mean? I know the flows are just estimated based off the power and RPM's, and that clots are a possibility with an increase in power, however, I was told that these would also show a deviation in the PI. I'm a little unclear of the effect of fluid status, preload/afterload on the numbers. These changes were explained as the result of the carvedilol that the patient had been started on 3 days prior. Seems to make sense to me that with a high afterload, the watts would be higher to push against it, but apparently the opposite is true. Can someone explain to me how this works? Also if anyone has a simple explanation of PI I would really appreciate it, its still a little fuzzy for me as well.

Thank you!

[ghillbert, MSN, NP]

Posted in error.

[questionsforall]

Was the patient fluid overloaded? What was his/her CVP? Was he on an inotrope?

I just had a patient with an LVAD that was in RV failure (pre-procedure R heart function was poor and post surgery RV failure increased) Anyway, without the RVad every little change in his fluid status would cause his ranges for the PI and it was a constant struggle to keep him within his narrow range of fluid balance. For ex. one unit of blood shot his CVP up to 13 and his PI's up to 5.6 (which was higher than they wanted). Then we gave him 20 mg lasix and he over diuresed him and his cvp dipped to 8 and his PI to a dangerous 3.2, w/in an hour of the lasix. Also, any drop in his ionotrope would cause a drop in his PI as well (very dependent on the ionotrope)

I guess my thought on this subject is that you really have to look at the patient's RV function.

[ghillbert, MSN, NP]

I really hate wasting my time posting a long response when the OP doesn't even bother coming back to read it.