LVADS in the community

Careful. It was inferred earlier that all EMTs are trained on VADs. I mentioned one, a friend of mine that was not. Clearly some EMTs are, some aren't, just like RNs or MDs for that matter.

Actually, I didn't see that there was an inference that all EMT's are trained on VAD's. My point, as you cared to highlight it is that there are inroads being made into training more and more first responders about VAD's. As more patients are implanted this type of training will become more and more necessary.

I have many friends who are EMT's and Paramedics. I find it disheartening that their training doesn't adequately prepare them to care for many patients...their learning takes place on the job, similar to nursing. But I also have to admit until we had an influx of VAD coordinators who actually cared about teaching, I became a self-directed learner about VAD's and now find them to be my favorite patient population. There is so much misconception out there about VAD patients which, in getting back to the origin of this thread-is clearly demonstrated. By thinking that VAD patients are too high risk to be handled at an outpatient dialysis clinic shows a lack of education regarding VAD's and their uses. It was that ultimate point I was trying to address.

As a side note, at no time in my post did I make a unilateral statement-which is what you seem to be implying. I wanted to share the experiences of our VAD center and maybe spur discussion amongst others.

Totally OTT but saw my first LVAD patient today!!! (I just started clinical in a major cardiothoracic ICU.)

I can understand your concern. There has been talk of us having a LVAD patient come to our unit as well. We are a hospital based outpatient hemodialysis unit but our hospital does not have an LVAD program. I appreciate the information offered here and I've read the comments that people lead active lives on LVADs but, as other people on this message board have expressed, my concern is that we are causing fluid shifts over 3 to 4 hours in our patients and no one in our hospital has any experience with care of patients on hemodialysis with an LVAD. I would appreciate hearing from any hemodialysis nurses in the community (as opposed to the hospital) who are dialyzing patients with LVADS in outpatient hemodialysis units. Do you assign a tech or nurse to the patient? Does the nurse covering the LVAD patient take as many patients as those nurses not caring for the LVAD patient? Do you have any special equipment to monitor MAP during the treatment? We've had our first inservice on LVADs, but it would be helpful to hear from someone who's actually delivered hemodialysis care to the LVAD patient in an outpatient unit and hear their experience and what special accomodations their unit has made to ensure safe care of an LVAD patient.

I can understand your concern. There has been talk of us having a LVAD patient come to our unit as well. We are a hospital based outpatient hemodialysis unit but our hospital does not have an LVAD program. I appreciate the information offered here and I've read the comments that people lead active lives on LVADs but, as other people on this message board have expressed, my concern is that we are causing fluid shifts over 3 to 4 hours in our patients and no one in our hospital has any experience with care of patients on hemodialysis with an LVAD. I would appreciate hearing from any hemodialysis nurses in the community (as opposed to the hospital) who are dialyzing patients with LVADS in outpatient hemodialysis units. Do you assign a tech or nurse to the patient? Does the nurse covering the LVAD patient take as many patients as those nurses not caring for the LVAD patient? Do you have any special equipment to monitor MAP during the treatment? We've had our first inservice on LVADs, but it would be helpful to hear from someone who's actually delivered hemodialysis care to the LVAD patient in an outpatient unit and hear their experience and what special accomodations their unit has made to ensure safe care of an LVAD patient.

wanted to take a moment to address a couple of your points. I've cared for many LVAD's on CRRT in our ICU. I realize outpatient is of course a different ball game but I have found flow on the LVAD to be a great first line assessment for fluid shifts. Depending upon the device, if a patient is becoming unstable, you will get flow and possibly speed variations which will clue you in to a possible problem. This can prompt you to assess BP.

BP in an LVAD can be a challenge. Best way to assess a continuous flow device patient's BP is via Doppler. Another alternative is to use a Terumo cuff (which is a special BP cuff that frequently works on LVAD's). However, if the BP is too low , even a terumo cuff may not help and you'll still want a Doppler BP.

i can't speak to staffing in your situation. But I do a lot of teaching with LVAdS and would be happy to help if I can. Feel free to contact me. Best of luck

Thank you so much for your reply and offer to help. My husband is a nurse and works with LVADs occasionally on a cardiac step down unit and has told me the same info about the BP and doppler. Their hospital has a LVAD team that can be there to troubleshoot in 5 minutes. I would feel so much better if I could hear from someone in the dialysis community that is doing this on an outpatient basis. Will be trying the American Nephrology Nurses' Association message board but I'm very grateful for your comments and the info provided by all here.