LVAD Nursing Care

Specialties Cardiac

Published

I work in a CTICU that implants 2-3 VAD's a year, am looking for helpful nursing care information. Thank you.:)

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I work in a CTICU that implants 2-3 VAD's a year, am looking for helpful nursing care information. Thank you.:)

I can probably get some info tomorrow at work. I work next door to HICU--Im sure they have plenty of info..

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I can probably get some info tomorrow at work. I work next door to HICU--Im sure they have plenty of info..

I found these on PubMed. They may be something to look into. I will still check tomorrow for ya :)

Items 1 - 4 of 4 One page.

1: Stahovich M, Chillcott S, Ferber L. Related Articles, Links

Management of adult patients with a left ventricular assist device.

Rehabil Nurs. 2004 May-Jun;29(3):100-3.

PMID: 15152420 [PubMed - indexed for MEDLINE]

2: Bond AE, Nelson K, Germany CL, Smart AN. Related Articles, Links

The left ventricular assist device.

Am J Nurs. 2003 Jan;103(1):32-40; quiz 41. Review.

PMID: 12544056 [PubMed - indexed for MEDLINE]

3: Christensen DM. Related Articles, Links

The ventricular assist device: An overview.

Nurs Clin North Am. 2000 Dec;35(4):945-59. Review.

PMID: 11072280 [PubMed - indexed for MEDLINE]

4: Bond E, Bolton B, Nelson K. Related Articles, Links

Nursing education and implications for left ventricular assist device destination therapy.

Prog Cardiovasc Nurs. 2004 Summer;19(3):95-101.

PMID: 15249769 [PubMed - indexed for MEDLINE]

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nursing care depends on which VADs you take care of

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We use ABIOMED where I work. The rep (an RN) will be glad to answer any questions and hold an inservice class. Since we implant less than 1 per year, we call him in for every implant.

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You have brave surgeons. We implant about 7 or 8 a year, and I think our surgeons are brave also. but they do work in many cases, and can be a bridge to transplant for those who are eligible.

Nursing Care:

Keep the tubing warm when it comes out from the patient and connects to the LVAD

Make sure your Bladders are filling and emptying properly. you should get a good squeeze in the top bladder, and see good ejection out of the bottom chamber. remember essentially these bladders are the left ventricle for now.

Not a good enough squeeze may indicate hypovolemia, or improper positioning of the pump. I don't like to move the pump up and down a lot because if you do this, how will you know if the patient needs volume or diuretics? Decreased force of contraction from the bottom bladder may indicate a high svr, and the pt. may need volume, nipride, or something.

check neuros every hour, esp. with IABP present.

don't do CPR

when heparin is started(when bleeding has stopped or 2 days post-op), maintain act about 200-240. ACT's should be checked hourly or at least every 2 hours. keep your ACT QA'd every 24 hours.

expect the patient to bleed for awhile, and to have to give multiple units (body replacements) of blood products.

for nursing staff in general, since you do so few per year, these patients should be 2:1.

expect to have to give a lot of volume post op.

know your numbers, and troubleshoots for the VAD.

That's all I have right now. I could tell you more, but it's all in a book somewhere.

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Specializes in Critical Care, Cardiothoracics, VADs.

The manufacturer websites/manuals are great sources of info. I work for one VAD maker, and as an ex-ICU RN, I write the manuals so I may be biased :) Abiomed also has an online learning module you can do. Thoratec.com is probably the best website to access as it has ALL of their manuals online.

Main thing is to leave the VAD alone and treat the patient around it in most cases (although not so much with the Abiomed - not sure if you mean ventricle or BVS5000?).

ALWAYS do sterile driveline dressings, beware of low flows (usually related to hypovolemia, tamponade or right heart failure in LVAD patients), manage anticoagulation closely, report any changed neuro signs early. PM me if you want to know any more about any of the other stuff. Also recommend many papers out of UPMC Pittsburgh, Columbia New York or Cleveland Clinic. Great high volume VAD centers.

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The cardiac unit (28 beds) I work on takes care of anywheres from 4-6 vads at a time- usually a few of them are staying on the unit for months waiting for transplant- they become like family members to the staff. We work with thoratec and more recenlty heartmate and heartmate II VADs. Most of our people are bridge to transplants a few have been 'destination' vads- no intent to transplant due to age.

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Specializes in Critical Care, Cardiothoracics, VADs.

They shouldn't be hanging around the unit waiting for transplant - most VAD patients can and should be discharged to home with a carer who can easily manage the device as an outpatient.

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Most do go home, for a bit- but typically end up back in the hospital for infections of the drivelines, issues with coumadin etc. There have also been issues with pump failure where pts have needed new units or even new drivelines placed. Considering that these are machines we are placing in or connecting to people- there are bound to be complications that arise and need to be dealt with.

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Specializes in Critical Care, Cardiothoracics, VADs.

Ah ok, thought you meant they are not discharged.

It is indeed unfortunate that technical complications often extend the hospital stay, and it's hoped that in the future the technology catches up to enable successful outpatient care.

What sort of driveline management does your hospital do?

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