LVAD and Cardiac rehab

allnurses Guide · Nov 10, 2009

Answered your other post. I work with VADs and send many to rehab either inpatient prior to discharge or in the community.

Main things:

- manual BPs using portable doppler required (can't use automated BP)

- maintain blood volume (answer to most problems is to drink more)

- any problems with dizziness etc, get them to lay down and elevate feet

- make sure you have their backup equipment (controller, power supplies) and know how to switch controllers in emergency (or that they do)

- protect their driveline exit site - make sure pt is wearing abdominal binder and immobilizing their lead.

lee1 · Nov 10, 2009

Thanks for the info, have you ever seen any problems personally?

allnurses Guide · Nov 10, 2009

I've seen lots of problems personally, but I work in a VAD program

What I listed above are the most common rehab issues, particularly dizziness/low flows.

Another possibility with continuous flow pumps like HM-II is SOB, which may indicate the pump speed needs to be increased to account for the excess activity once patient gets more mobile. If you have lowish pump outputs (

lee1 · Nov 10, 2009

So far, this patient has only come in for 4 visits. He has underlying COPD but is listed status 1B. He wears O2 while he is exercising only. Hopefully his COPD will clear up more before TX. He does have some SOB generally after the last exercise but it resolves as soon as he rests a minute and his pulse ox comes up. We are not pulmonary rehab, so not used to dealing with this aspect. I do encourage him to drink water if he feels thirsty.

Do you have any guidelines or policies for this type of patient at phase II cardiac rehab???

I have been making something up but always nice to see others.

Lee RN

allnurses Guide · Nov 11, 2009

Unfortunately the VAD can't help his COPD, although it can help reduce PA pressures over time with better offloading. Make sure he tells his VAD team when he goes to clinic that he is getting SOB with exercise - he may need pump speed increased if he has a high PI, but you won't be able to tell without hooking him to monitor.

We do have a protocol, I'm having it sent to me and will forward. Are you looking for pump related issues or what type of exercises etc? I can ask our PTs if they have anything also.

lee1 · Nov 14, 2009

Unfortunately the VAD can't help his COPD, although it can help reduce PA pressures over time with better offloading. Make sure he tells his VAD team when he goes to clinic that he is getting SOB with exercise - he may need pump speed increased if he has a high PI, but you won't be able to tell without hooking him to monitor.
We do have a protocol, I'm having it sent to me and will forward. Are you looking for pump related issues or what type of exercises etc? I can ask our PTs if they have anything also.

Thanks again for the info, we are watching him carefully, at this point he only needs to use the O2 when he is exercising. He is listed 1B, but then he is type O, which puts him further down on the list. If you have any protocol please send to me. Would really appreciate it.

Lee

Editorial Team / Admin · Nov 14, 2009

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thank you.

allnurses Guide · Nov 14, 2009

??? What's that for?

cardiac rehab rn · Oct 20, 2010

We are admitting a pt with an LVAD (first one) next week. Can you send me your protocol please?

[email protected]

skkrrt · Dec 28, 2010

We also are admitting our first LVAD patient and would like to ask for protocol / care / emergency information please.

[email protected]

allnurses Guide · Dec 31, 2010

Go to Thoratec - Innovative Therapies for Advanced Heart Failure

for manuals, presentations, academic papers and guidelines about the Heartmate II pump.