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If you are a nurse at a rural hospital, you may have had a patient arrive at your hospital with an LVAD, and you may have felt uncomfortable with this unfamiliar device. If so, you probably wanted to learn more about LVADs and how to properly care for your patient. Read this article to learn more about LVADs and what steps you can take if you happen to have a patient show up at your hospital with an LVAD. Disclaimer. Nurses who work at LVAD centers are trained on how to properly care for patients with LVADs. This article is not considered a training manual and does not encourage untrained nurses to manage LVAD devices; however, it provides an overview of what an LVAD is for your knowledge base and what to expect if you happen to see one in your hospital. What is an LVAD? LVAD stands for Left Ventricular Assist Device. An LVAD is a treatment device for advanced heart failure. The goal of the LVAD is to assist the heart in circulating blood to the body in a heart that is otherwise too weak to adequately pump blood. The device is implanted in the apex of the left ventricle and connects to the aorta via a cannula. Using power, the device moves oxygenated blood from the left ventricle to the body. A driveline cable connects the internal portion of the device to an external power source by exiting the body through the abdomen. The exit point is commonly called the driveline site. Once outside the body, the driveline connects to the controller (the brain of the device) and two power sources. An LVAD device essential replaces the pumping action of the heart. Current devices are commonly referred to as continuous-flow devices. This means that blood is continually circulated through the device and to the body, thus masking the pulsatile effect of the heart, often eliminating pulse detection. Indications Listed below are three common treatment tracks for patients with LVADs. 1- Bridge-to-Transplant This treatment option is used for patients who qualify for a heart transplant and are listed on the heart transplant list. Patients in the bridge-to-transplant track will get an LVAD temporarily until a donor's heart is available. 2- Destination Therapy Patients who do not qualify for heart transplants fall into the destination therapy category. For these patients, an LVAD is the final treatment option for their advanced heart failure. In this tract, most patients keep the device for life. 3- Bridge-to-Recovery Patients who need temporary left ventricular support fall into this category. The goal is to remove the device after the heart shows signs of recovery. Components of an LVAD Implanted pump. This is the internal portion of the device. The pump is implanted in the apex of the left ventricle and connects to the aorta via a cannula. Controller. The controller is located outside the body and monitors the pump. It is considered the brain of the device. If something is wrong, it will notify you with alarms. Driveline. The driveline has both an internal and external portion. It connects the internal pump to the external controller by exiting the body through the abdomen. The exit point is called the driveline site. Power source. The external power source connects to the controller and powers the pump. This component is extremely important because, without power, the device does not run. Some devices have a temporary backup power source built inside the pump, but patients are taught never to rely on this. What does Life Look Like with an LVAD? Patients can live fairly normal lives with LVAD devices. They are encouraged to be active. Some patients get back to dancing, gardening, golfing, and even playing tennis. Patients will take anticoagulants for as long as they have the device. They are not allowed to swim because they can't submerge the device in water and are discouraged from doing contact sports because of bleeding risk. No pulse? No blood pressure? No Problem! Because LVADs are continuous flow devices, it is common for patients not to have palpable pulses or easily detected blood pressures. Instead, clinicians measure and monitor mean arterial pressure (commonly referred to as MAP) in patients with LVAD devices. Use a Doppler to Check MAP in an LVAD patient without a pulse Place a blood pressure cuff on the patient's arm Using a doppler placed over the brachial artery, listen for an audible swooshing sound Slowly inflate the blood pressure cuff until the audible sound goes away Deflate the blood pressure cuff until you hear the return of the audible sound Record this number as the MAP The typical MAP goal is 80 mmHg What are the Risks of LVADs? Stroke and Pump Thrombosis. The formation of blood clots in the device is a major risk. For this reason, patients will be on warfarin for as long as they have the device. There is a risk for both ischemic and hemorrhagic stroke in patients with LVADs. Bleeding. Because Patients with LVADs will be on warfarin, the risk for bleeding is high. Infection. Infection may occur internally in the pump or externally at the driveline site. LVAD coordinators extensively educate patients on at-home driveline site care to prevent infection. The driveline site should be kept clean, dry, and covered. Patients change their dressing sterilely once a day at home. RHF. There is a risk of right heart failure developing following the placement of an LVAD. RVADs (right ventricular assist devices) do exist; however, they are less commonly seen in the community. Common Types of LVADs Let's discuss the most common types of LVADs seen in the community. Medtronic's Heartware (also called HVAD) and Abbott's Heartmate2 and Heartmate3. Heartware HVAD The HVAD controller should always have two sources of power; either two batteries, or one battery and one AC/DC power cable. Charge batteries in the battery charger. Numbers. The HVAD controller has 3 numbers listed on its screen. RPM shows the speed of the device measured in pump rotations per minute. L/min monitors blood flow in liters per min. Watts measures the power level of the pump. Changes in numbers can indicate complications such as pump thrombosis or worsening heart failure. Changing power sources. Patients are educated on how to change power sources and batteries. Find out how to change power sources at the end of this article. Alarms and what they mean. Read about the attached alarm guide from the manufacturer. Product Update. Medtronic stopped the distribution of new HVADs in June of 2021 due to complications with the pump. Medtronic is not currently recommending the replacement of HVADs, so you will still continue to see patients with HVAD devices in the community. Abbott's Heartmate2 and Heartmate3 Heartmate3 is Abbott's updated model. Both versions have similar controllers. The heartmate LVAD has a power unit that connects to an AC outlet in order to provide power. Patients will connect to the power unit while they are sleeping or resting indoors. The heartmate also comes with portable batteries. Charge batteries in the battery charger. Numbers. Both Heartmate2 and Heartmate3 controllers will show 4 numbers on their screen, viewed one at a time by pushing the square display button on the controller. Pump speed is measured in RPMs (rotations per minute). Flow Indicates blood flow in Liters per min. Power is indicated in Watts. PI stands for pulse index. The range is 1-10 per manufacturer. Changing power sources. Patients are educated on how to change Heartmate's power sources and batteries. Find out more details at the end of this article. Alarms and what they mean. Read for further information on Heartmate3 alarms. Who Should I Contact for Questions or Concerns? Contact the manufacturer's local device representative. LVAD patients should know who their local device rep is and how to contact them. Patients should have the rep's contact information readily displayed in their device kits and/or listed on their phones. Dos and Don'ts with LVADS Do Encourage the patient to be the owner of their device if possible while they are hospitalized. Enlist the help of a trained family member if the patient is unable to care for themself. Always keep the device connected to two sources of power. Keep the emergency contact number for the manufacturer handy in case of an emergency. Monitor INR because the patient will be on warfarin. The typical INR goal range is 2-3. Have the patient change their driveline site daily. This is done using sterile technique. They typically use gauze, spit gauze, betadine, and tape. Monitor the driveline site. Look for signs of infection. Always keep at least two backup batteries and the backup controller with the patient at all times. Don't Submerge device in water Change power sources for the patient without training Disconnect both power sources at the same time! Manage the pump without official training Commonly Asked Questions Q. Can my patient shower? A. Yes. A special shower bag is used to cover the device to prevent it from getting wet. Dressing changes are performed after a shower. Q. How do I know if the pump is running? A. You will hear the humming sound of the pump when auscultating the patient's upper left chest with a stethoscope. Q. My EKG reading shows artifact. Is this normal? A. EKG readings are difficult to pick up in patients with LVADs as the device may create electromagnetic interference. Oftentimes it requires adjusting lead placement. Q. If my patient codes, what do I do? A. Follow the manufacturer's guidelines. There are risks associated with chest compressions. Both Heartware and Abbott advocate using clinical judgment. Where Can I Find More Info? Read more about Medtronic's Heartware HVAD. Learn more about Abbott's Heartmate2. Find more info on Abbott's Heartmate3. How to Change Power Sources for Heartware HVAD Line up the solid white arrow on the power connector with the red dot on the controller and gently push the cable into the controller until you hear a click. Confirm connection by gently tugging back on the power cable. To disconnect, grasp the power cable at the connection site. First, turn counterclockwise, then pull the cable out of the controller. Never Disconnect both power sources at the same time! This will make the pump stop. For safety, always have 2 power sources connected! How to Change Power Sources for Abbott's Heartmate2 and Heartmate3 Switching from power unit to battery. Place two batteries in two clips by lining the red arrow on the batteries with the red arrow on the clips until a click is heard. Disconnect the white power cable from the white power unit system. Align the half circles and pins of the white power cable with the first battery and push, tighten until secure. Repeat with the black power cable and the second battery. Changing from batteries to power unit. Reverse the process by first disconnecting the white power cord from the first battery then connecting it to the white cable on the power unit. Then, disconnect the black cable from the second battery and connect it to the black cable on the power unit. Changing batteries while on battery power. Press the power release button on the clip and remove the battery. With a new battery, line up the red arrow on the battery with the red arrow on the clip. Repeat with the second battery. To avoid damage, do not twist the connection when aligning pins Always connect white to white and black to black References/Resources Left Ventricular Assist Devices Outcomes based on blood pressure in patients on continuous flow left ventricular assist device support: An Interagency Registry for Mechanically Assisted Circulatory Support analysis Hypertension, Arterial Compliance and LVAD Pump Function Understanding Left Ventricular Assist Devices Ventricular assist device (VAD) Left Ventricular Assist Devices (Mechanical Circulatory Support MCS) Treating patients with Left Ventricular Assist Device (LVAD) HeartMate 3™ Left Ventricular Assist Device: PUMP PARAMETER OVERVIEW HeartMate 3 LVAD HeartMate II™ Left Ventricular Assist Device Medtronic HVAD Learning Center INDICATIONS, SAFETY, AND WARNINGS Medtronic HVAD™ System Abbott Cardiovascular

Thank you for your feedback. You make a really good point in saying that we need more time. As nurses, we constantly feel like we are running out of time. Adding mental health care to an already overloaded system can seem like an impossible task indeed! This can be particularly frustrating because, in order to thrive holistically, it is necessary to foster mental health. As you also pointed out, real conversations from supportive listeners help us feel heard. This echos my main point of this article, that we need to start the conversations. We have to start somewhere, and most often change starts with a conversation. In this case, feeling safe enough to initiate conversations knowing that the vulnerable things you reveal to another person will be heard, supported, and not shamed.

There is an elephant in the room filled with nurses. A looming presence that we choose to ignore, an ever-present force amongst us, and nobody wants to talk about it. This elephant is our mental health. As nurses, we are holistically trained. We learned in nursing school to consider the mind and spirit as well as the body when we assess our patients. So why is it that we are often hesitant to discuss our own personal mental health struggles? Why don’t we look upon ourselves with the same consideration and treat ourselves with the same kindness as we do with our patients? As depression and anxiety rates increase amongst nurses, now more than ever, it’s time to talk about our mental health. Rates of depression and anxiety are on the rise amongst nurses, particularly in light of COVID-19. According to a recent survey performed by American Nurses Association, 40% of nurses reported feelings of depression. Although mental health struggles are increasing with COVID-19, they are not new amongst nurses. Prior to COVID-19, an Australian study of 102 nurses found depression in 32.4%, anxiety in 41.2%, and stress in 41.2%. although no one wants to talk about it, mental health issues are prevalent amongst nurses. Yet it seems like we are afraid to discuss these vulnerable aspects of ourselves. Why is that do you think? Why We Don't Talk About Mental Health Issues Historically, nurses have prided themselves on being strong-minded and capable. We are prone to self-sacrifice and value heroism. We fear the seemingly social stigma that is associated with mental health issues. We believe that we have to be held to a higher level of functioning, so we give our all. This, in turn, can lead to burnout which can significantly contribute to mental health issues such as anxiety and depression. Contributing Factors To Anxiety And Depression Stress It’s no secret that our day-to-day jobs as nurses are filled with stress. We encounter stress every single day, and sometimes all throughout the day. Stress takes a toll on our bodies, both physically by raising cortisol levels thereby leading to chronic health conditions, and mentally by triggering anxiety and depression. Today we are dealing with an astronomical force of added stress related to COVID-19. We’ve been working longer hours, we’re shorter staffed, and we’ve had to deal with limited resources. This added stress is affecting nurses all across the world. Burnout Along with COVID-19, rates of burnout are on the rise amongst nurses. Burnout is often caused by prolonged stress and is characterized by emotional, mental, and physical exhaustion. A survey done on Canadian nurses found that 63.2% reported some symptoms of burnout and 29.3% reported significant levels of burnout. The study noted that “higher levels of burnout were associated with higher levels of anxiety, stress, and depression symptoms.” In this time of COVID-19 more and more nurses are being pushed to their limits and are unfortunately reaching burnout. We are exhausted. We’ve been fighting this battle for two years and sadly we don’t have an end in sight. We’re in this for the long haul. Now, more than ever, we need assistance in developing positive coping mechanisms. Compassion Fatigue Compassion fatigue coincides with acute mental health issues and is particularly prevalent today with COVID-19. The Merriam-Webster dictionary defines compassion fatigue as “the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time.” The prolongation of the COVID-19 pandemic is pushing compassion fatigue to new heights amongst nurses. Compassion fatigue significantly contributes to burnout. It may cause increased feelings of hopelessness amongst nurses, leading many nurses to consider leaving the nursing profession altogether. What To Do About It Awareness of an issue is the first step to initiating change. We need to talk about mental health issues amongst nurses. We need to be aware of the prevalence of mental health issues amongst nurses so that we can address them. Let’s be compassionate to ourselves by starting the conversation. Practicing Mindfulness and other Self-Care Habits Self-care habits such as getting enough sleep, eating well, exercising, and practicing mindfulness are excellent lifestyle behaviors that boost mental health wellness. These self-care behaviors are associated with improving and preventing anxiety and depression. Mindfulness is the practice of returning to the present moment and is often achieved through practicing meditation and yoga. Support Groups Support groups are a valuable resource for mental health wellness as they assist people in finding and maintaining community support. Support groups provide a network of like-minded individuals dealing with similar issues and offer a non-judgmental space to discuss sensitive topics. We need to promote support groups amongst nurses to increase awareness, availability, and attendance. Mental Health Counseling/Therapy Mental health therapy should be promoted more amongst nurses. It should be easier for nurses to find mental health counselors, and time off should be encouraged for this essential treatment. Some examples of ways to increase use amongst nurses are placing mental health fliers in the break rooms, management promoting self-care habits, and easy-to-find online resources for therapy and support groups on our intranet websites or portals. Supportive Workplace Environments If workplaces support holistic wellness cultures and encourage their nurses to seek available mental health resources, then nurses feel empowered to seek out mental health care without fear of social stigma. Mental health wellness is key to building a stronger and healthier nursing workforce. If we do not promote mental health practices and support our nurses struggling with mental health issues, then rates of depression, anxiety, and stress will only continue to rise causing even more nursing staffing shortages as nurses reach compassion fatigue and burnout. It is in management’s best interest to promote healthy self-care habits and provide easy access to mental health resources. Call To Action If we change the story, we change the stigma, then we can change the outcome. The more we talk about mental health issues amongst nurses in a non-judgmental supportive manner, the more nurses will know about resources available to them and not feel afraid to seek out those resources for fear of stigma or shame. As seasoned nurses, it is our responsibility to support the next generation of new nurses, to set them up for success by promoting mental health wellness. It’s time to change the story, promote healthy mental health practices, and support our nurses who struggle with mental health issues. References American Nurses Association. (2021). New Mental Health and Wellness Survey Finds Depression Increasing Among Nurses. National Library of Medicine, PubMed.Gov. (2018). Prevalence and Risk Factors of Depression, Anxiety, and Stress in a Cohort of Australian Nurses. National Library of Medicine, PubMed.Gov. (2021). Associations Between Burnout and Mental Disorder Symptoms Among Nurses in Canada. Merriam Webster. (2022). Compassion Fatigue. Psychology Today. (2022). Burnout. Psychology Today. (2021). 7 Simple Habits to Protect Your Mental Health. National Institute of Mental Health. Mental Health Information.

It is no secret that in today’s world we are living in an age of misinformation. From social media platforms that tend to create echo chambers and house self-proclaimed experts promoting their personal beliefs, to conspiracy theories and seemingly political agendas, misinformation is shared and reshared at an alarming rate. Unfortunately, COVID-19 has entered this sea of misinformation leaving many people uninformed about COVID-19 and evidence-based healthcare practices. People want to hear the truth about their health and are looking for guidance to make well-informed healthcare decisions. As nurses, how do we best fight this battle of COVID-19 misinformation? The answer is with education. Nurses have a unique ability to communicate across the healthcare spectrum. We are experts in translating medical jargon into plain language in order to ensure that our patients understand their healthcare, and we have the tools to communicate higher-level medical terminology amongst our colleagues. Who is better fit to educate the public on health-related matters, particularly COVID-19? We have a voice, a passion for healthcare for all, and the knowledge needed to educate everyone. It’s time for nurses to take the lead on COVID-19 education. People Trust Nurses Historically, nurses have been considered one of the most trusted professions. According to the most recent gallop poll, nurses ranked highest as the most trusted profession, earning a record of 89% (very high/high) score for honesty and ethics. Gallop further highlights that nurses have been at the top of the list for every year since they were added in 1999 except for 2001 when firefighters ranked the highest due to the September 11 incident. Armed with the knowledge of this incredible trust that people place upon nurses, it is imperative that we use our voice, pen, or web platforms to educate the public. Nurse education is the solution to turning the tide on COVID-19. What is Our Platform? Our platforms are community-specific. Whether we work in primary care, schools, critical care, inpatient units, parish nursing, or community health, we can use our voice in our communities and workplaces to educate the public. Change starts locally in our communities. Small droplets of change that turn into ripples that manifest into waves that help turn the tide on COVID-19. Nursing Niches: How Can We Make a Difference in Our Communities and Workplaces? Outpatient Clinic nurses have a responsibility to educate patients on all aspects of COVID-19 as well as triage potential COVID-19 patients to their best level of care. In-patient nurses are on the frontlines of COVID-19, caring for sick patients and educating them upon discharge. Parish nurses are a valuable educational resource to their church communities, having the potential to reach many people who may not seek out healthcare from hospitals and clinics. Critical care nurses are on the battlefield of COVID-19, actively saving lives as they fight the virus. Nurse writers are incredibly important in the misinformation battle against COVID-19 as their words may reach thousands of viewers and span across communities. All nurses must band together to fight COVID-19 misinformation and provide evidence-based information to everyone. School Nurses are a Hot Topic Right Now As children all around the nation are returning to school, many parents and children are frightened, and many are uninformed about best healthcare practices. School nurses are invaluable today as they provide quality health education to students who in turn will bring those learned health practices home to their families. This generational health education may help turn the tide on COVID-19. The big question that everyone is asking is how can we keep our kids safe? The Centers for Disease Control and Prevention (CDC) recommends universal masking and maintaining a physical distance of at least 3 feet between students in K through 12 schools. School nurses should provide education to students on why this is important, utilizing age-appropriate language so that all children understand the reasons behind this requirement. Children are more willing to comply with rules if they understand the reasons behind them. School nurses may need to be inventive in coming up with creative methods for children to interact with each other while following the CDC guidelines. School nurses have never been more important than they are today. Our nation relies heavily on their presence in schools to monitor, educate, and protect our children. Another Sounding Board for Nurse Education is Social Media Nurses can utilize their social media platforms to post evidence-based health information related to COVID-19. Nurses have the unique ability to interpret complex scientific language into plain English that can be understood by all, and social media platforms are easy places for nurses to reach people in their communities. As we learned earlier, people trust nurses and they want to hear from us. Okay, so we have an audience, now what? What are the Things that Nurses Should Say? Nurses should continually refer to the CDC website for current guidelines. Here are examples of some of the most important COVID-19 related education topics: Promote vaccines It is imperative that nurses continually provide information on vaccine safety. According to the CDC, over 396 million doses of COVID-19 vaccines have been given in the United States as of the time this article was written. Regarding vaccine safety, the CDC states that tens of thousands of participants were evaluated in COVID-19 vaccine clinical trials, and the vaccines met the FDA standards for safety, effectiveness, and manufacturing quality. The CDC wants the public to know that vaccines are safe and effective. The CDC states that serious safety problems from COVID-19 vaccines are rare, results from vaccine safety monitoring efforts are reassuring, and common side effects that some people may have include swelling/redness/pain at the site, tiredness, headache, muscle ache, fever, and nausea. It is important that nurses repeat this information in their workplaces and communities. Promote hygiene practices Nurses should provide education on best hygiene practices and how quality hygiene practices decrease virus transmission. The importance of proper handwashing to prevent the spread of the virus cannot be stressed enough. Proper handwashing techniques include washing hands with soap and water for at least 20 seconds or rubbing hands with a hand sanitizer that contains at least 60% alcohol. Nurses should recommend frequent disinfection of highly touched surfaces in the workplace and schools. Promote masking Know when to mask up and why masking matters. The CDC recommends that unvaccinated people wear masks while indoors and in crowded outdoor settings. Fully vaccinated people should wear masks while in indoor spaces that are in areas of high transmission. Because COVID-19 spreads when an infected person breathes, coughs, or sneezes droplets and small particles that hold the virus, masks are important because they contain those droplets and particles and prevent them from spreading to others. Wrapping it All Up Nurses are experts in education, have been voted the highest trusted profession, and are proficient in tailoring language to the appropriate educational level of their audience. Misinformation is wreaking havoc amongst our communities. Nurse education is the solution to turning the tide on COVID-19. There are around 4 million Registered Nurses in the United States. If every one of those nurses raised their personal bar on COVID-19 related education amongst their communities and workplaces, then evidence-based information would reach more people. Education is the best weapon to fight misinformation. We can do this! Go forth and educate! References/Resources Centers for Disease Control and Prevention: COVID-19 Centers for Disease Control and Prevention: Safety of COVID-19 Vaccines Centers for Disease Control and Prevention: Guidance for COVID-19 Prevention in K-12 Schools Centers for Disease Control and Prevention: Transmission Centers for Disease Control and Prevention: When You’ve Been Fully Vaccinated Centers for Disease Control and Prevention: How COVID-19 Spreads Centers for Disease Control and Prevention: How to Protect Yourself & Others U.S. Ethics Ratings Rise for Medical Workers and Teachers American Nurses Association (ANA): Workforce