What should I know about a left ventricle assistant device (LVAD)?

Rhi007 · Feb 15, 2013

That would be a question to bring up with either the treating cardiologist or CT surgeon that put the device in and also your CN. They would be the best people to ask advice as they will know

classicdame, MSN, EdD · Feb 15, 2013

I recently had Thoratec come out to train our staff (nursing, RT, lab, anyone who would attend). They have training videos on their website, but they pertain MOSTLY to the staff who work in the transplant centers. If you go to thoratecu.com and take the course designed for EMS you will learn the basics. Pts. do not have a pulse, CPR could destroy the pump and the power pack is worn on the outside and needs recharging. The best thing to know is that the tag hanging off the accessory bag is whom you call first. Some pts. will live in heart failure for a while if the power goes off, but some will not. Depends on how severe the heart failure was before implant was done. We have about a dozen patients in our area so I was trying to be pro-active. Maybe your educator will want the same.

loubeav · Feb 22, 2013

Thank you so much for the info. Do you have to be a provider to create an account on that website?

Aliakey · Feb 23, 2013

That registration process is a pain... I just tried to do it, and apparently they manually-approve each applicant. And it's a weekend, and... lol!

If it helps: During my EMS training on the Heartmate products (Thoratec) about a year ago, we needed to be aware of not only the newer line (Heartmate II), but we also have patients in our area with the older Heartmate I and other devices.

There's a lot of information to absorb, but some key Golden Rules that might help you with these LVADs:

1. There will be no pulses and no blood pressures you can obtain by a standard cuff... just listen for the thrill from the pump whirring, the patient's skin color, etc. The alarms on these devices are important, and the patient's family or his "Go!" pack should have a reference card for them. The families and patients in our area are HIGHLY trained on the pumps, what to expect, what constitutes a problem, and what needs to be made immediately available (such as the "go" bag or pack that includes a full set of charged batteries, reference cards, etc.). Please listen to these trained family members; they are INVALUABLE.

2. If the pump is not working and the patient is not responsive to stimuli, we immediately go to chest compressions on the Heartmate II device (which is allowed because 'dead is dead' if we do nothing; careful on correct hand placement to prevent dislodging the device). On the older devices, there is a handle of sorts we attach to provide manual flow, so you don't do compressions directly that would damage the device (as mentioned by classicdame).

3. Preload and afterload is very important for these patients in our pre-hospital setting, as these pumps need something to work with. We avoid nitroglycerin, morphine, furosemide, and other potentially vasodilative or diuretic medications, and leave those treatment decisions to the receiving hospital. Otherwise, we continue with cardiac monitoring, IV establishment, oxygen, diesel bolus (ambulance, not IVP :) ), etc. as needed.

4. We do not give aspirin in the field. These patients are already anticoagulated well with home medications that prevent any clots from forming in these pumps.

5. Defibrillation/cardioversion is permitted if needed. It's very strange to have a patient in V-fib talking to you and only reporting weakness and dizziness. In this case, the blood is still being pumped by the device to the brain, but the heart's dysrhythmia must be treated.

I'm sure there's a ton of information for in-hospital care and would really love to hear that end of it too (hint, hint), but thought I'd offer some treatment pearls from the EMS side.

Hope it helps.

loubeav · Feb 25, 2013

Oh wow, you are awesome. Thank you so much for the help!

KelKelKel · Mar 10, 2013

As an LVAD nurse, I can tell you #1 listen to the pump (steth or even naked ear over left upper quad of abdomen, about where their stomach is) you will hear a humming noise. If you hear that constant humming, the pump is working and you have circulation, move on to securing an airway. By this time, hopefully, you should have been able to get them on a monitor to determine rhythm, BP (not all VADs on non-pulsatile), and sats. Look at your entire clinical picture. Go from there. Vads are pre-load dependent so you treat your pressures with fluids. Hopefully your hospital will have a monitor to hook the PT up to so flows, speed, events, can be assessed and treated. Whatever pump they have, Heartmate I or II, Heartware, Syncardia, etc. it will be VERY noticeable once the shirt is removed from the patient (there will be a covered driveline protruding from their abdoment with a control unit attached). If someone is moving into the community, their VAD coordinators should have already been in contact with local Drs/Hospitals/EMS about how to handle this patients care.

KelKelKel · Mar 10, 2013

Addendum to above post: BP (not all VAD PATIENTS are non-pulsatile),

Ruby Vee, BSN · Mar 10, 2013

There was a lot of great information on the Heartmate II. Not every home LVAS is a Heartmate, though. First thing you need to know is what KIND of LVAS is it. Then you can look it up online.

classicdame, MSN, EdD · Mar 11, 2013

you do not have to be a provider but you have to get pre-approval. They do not want patients reading things about possible complications, etc. without the benefit of interpretation by a healthcare provider. Write the webmaster or call. As long as my staff goes through me I can request they be enrolled. Lots of good free info. Or call the mfg rep. That is how I started.