new device...a little rant

jmtndl · Feb 14, 2015

I just attended an inservice on a new device. It is an LVAD pump on a catheter that must be placed exacxtly between the left ventrical and tha aortic root and sucks blood from the ventrical and gooshes it into the aorta. I am seriously wondering about my reaction. This device could save lives in very specific clinical situations, but I am afraid it will be used as a life prolonging tool in unfixable situations when the familys have been poorly educated by the doctors and anticipate seeing it utilized in very elderly patients whose hearts are completely failing and who cannot recover but can die with their families saying "we did eveything for Mama".I don't even know what I am trying to say, but I see this device as leading to tortured deaths where the poor patient must be immobilized, not turned and made comfortable, and will die in agony.Will there ever be a voice of reason for the acceptance of death and the best interest of the patient.Does anyone else understand what I am feeling?

nurseprnRN, BSN, RN · Feb 14, 2015

Yes, but your fears are misplaced. This is a ventricular assist device that takes some of the workload off a failing left ventricle (spelling) and is usually used as a bridge to transplant for someone who has been accepted as an organ recipient who is awaiting a donor organ, not as a last resort to maintain circulation in a dying person who wouldn't meet transplant criteria.

It may help you to remember that people thought the same thing when pacemakers were invented. They don't work in people who are FTD (fixin' to die) either.

Editorial Team / Admin · Feb 14, 2015

Honestly, I think your fears will turn out to be unfounded. Most facilities and the organizations behind certifying facilities as well as professional organizations (one of the key ones here being transplant) require strict criteria when considering patients for interventions such as these. My facility does, on average, 2 LVAD implants per year. Does that mean only 2 patients are evaluated each year? Absolutely not! Many patients are referred and found not to qualify.

We also have both Impella devices and Tandem Heart devices as well as ECMO capabilities. Again, these require strict (albeit at times very quick) assessment of meeting criteria. For those that are questionable and both family and cardiology agree to insert, it is reevaluated daily and removed/turned off if patient is deemed to not meet criteria (complete lack of any neuro functioning for example).

You can also always contact the ethics committee of your facility. It may not affect a current patient, but it may affect considerations for future patients.