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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Cardiology, Cardiovascular Surgery

Going Home with a Thoratec TLC-II VAD (6674)

Going Home with a Thoratec TLC-II VAD (6674) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Cardiology, Cardiovascular Surgery

6674




Going Home with a Thoratec TLC-II VAD

While living at home with your ventricular assist device (VAD), it is vital that you follow these
instructions. You must know and understand the warnings and cautions that go along with
having a VAD. Be sure that you are aware of the guidelines for safe VAD function.

Daily Care

1. Dressing Change
a. Change the driveline exit site dressing at least once a day. Be sure to use the sterile
technique in the attached instruction sheet.
b. Keep the driveline from moving around with tape or an anchoring device discussed with
you in the hospital. This prevents infection.
c. Take a good look at the driveline exit site at least once a day. Do this during the dressing
change. Look for signs of infection.
ξ Redness
ξ Swelling
ξ Drainage (blood or pus)
ξ New drainage where there was not any before
ξ Increased tenderness during dressing change
ξ Foul odor
ξ Increased warmth at the site
ξ Temperature of 100° F

2. Each day, record the VAD readings as taught to you in the hospital.
a. Vital signs should be done and recorded on your flow sheet
ξ Blood pressure
ξ Weight
ξ Temperature
ξ VAD readings (mode, rate, flow, presence of flash test or empty light, presence of
fill light). If you have a BiVAD, record both LVAD and RVAD readings.
b. Every 4-6 hours check these items. Call your VAD coordinator if they are not
normal.
ξ For percutaneous VAD, check the flash test as demonstrated in the hospital.
ξ For implantable VAD, check the empty light for consistent flashing.
Weekly
ξ Clean the fan with a lint free cloth. This will prevent the console from getting too hot. It
will also prevent dust build-up.
ξ Inspect batteries and wipe the metal contact with alcohol swab and let air dry.

Fill Light – If the fill light is not on, trouble shoot for a loss of fill light. If you are not able to
fix this, call your heart failure attending.




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System Care and Monitoring

1. Do not kink your driveline(s).

2. Keep water or moisture or debris from your console.

3. Do not tighten connections using a tool. Do not clean the connections. If there is
something wrong, call the VAD coordinator or heart failure doctor on-call.

4. Do not plug the console into an outlet controlled by a wall switch.

5. Do not forget – at least one battery must be in the console at all times.

6. Do not expose batteries to extreme heat or cold.

7. Rotate batteries into the battery charger. This helps to charge them. It also helps them
last longer.

8. If you have a problem with a battery, mark it and set it aside. Contact your VAD
coordinator during daytime hours to let them know that you need a new one.

9. The carry case is water resistant. It is not waterproof.

10. Do not use surge protectors or extension cords for either the console or the battery
charger. Plug drive console and battery charger directly into a grounded outlet only.

Activities

ξ Do not take baths or go swimming while implanted with the pump.
ξ You may take a shower only after your doctor has told you that you are able to. Do not
take showers without using the shower process discussed with you by the VAD
coordinator.
ξ Do not let water or fluids get into your console. Water that gets into the pump or fan
can cause your pump to stop. Avoid activities that would cause your pump to get water
into it such as tub baths, whirlpools, swimming.
ξ Do not play contact sports while implanted with the VAD.
ξ Avoid jumping up and down.
ξ No lifting more than 10 pounds for at least 8 weeks. You must get approval from the
surgeon to lift more.
ξ Be careful using computer equipment or television. These items emit static electricity.
ξ Do not vacuum.
ξ Keep the TLC -II by your bed when you sleep. You need to be on the wall outlet power
when you go to sleep.
ξ Do not sleep on your stomach.
ξ Do not bend at the waist. This will kink the cables. It could cause the pump to stop.



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Lab Tests

You will be on a drug called Coumadin® (Warfarin). It is a blood thinner. You will have to have
blood tests done at your local lab and will be monitored by the Heart Failure team. The blood
test drawn is called INR (international ration which monitors Coumadin®).

Medical Care

ξ You may have a CT scan or X-Rays.
ξ No MRI
ξ No chest compressions
ξ External defibrillation – no change to the pump is needed.

Pain

ξ By the time you are ready to go home, you should not be having much pain.
ξ Medicine for pain will be given to you and should be taken as ordered.
ξ If you have any change or increase in pain, call your doctor right away.

Diet

ξ It is vital to eat foods high in protein and calories.
ξ You need to control salt and fluid intake.
o Limit salt intake to 2000mg.
o Restrict fluid intake to 2000 ml.
ξ Since this device is near your stomach, you may feel full faster. You may need to eat
smaller meals more often during the day rather than a few large meals.
ξ If you have diabetes, be sure to discuss your diet, nutrition supplements, carbohydrate
counting and meal planning with your doctor. Eating protein is vital for your healing.

Smoking and Tobacco products

ξ Smoking and second hand smoke cause your arteries to tighten. This will decrease blood
flow. Your pump will have to work harder.
ξ Smoking and second hand smoke also lower your ability to fight off infection.
ξ Do not smoke. Avoid places where you will be around second hand smoke.

Alcohol

ξ Do not drink alcohol.
ξ Alcohol interferes with some medicines.
ξ Alcohol makes you urinate more often. It can cause you to dehydrate. Your VAD
depends on enough blood supply to work best.
ξ Alcohol will impair your ability to understand and react to system alarms.






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Weather

ξ Avoid being active in very hot or cold temperatures.
ξ If you go outdoors during very hot or humid weather, be sure to drink lots of water and
non-alcoholic drinks.
ξ Before going outside in the cold, take care while putting on heavy clothing, coats, or
jackets, to avoid kinking, bending, or blocking your drive line, VAD cables.
ξ The console can overheat if sitting in the direct sunlight after 15 minutes in the summer.

Home Safety

ξ Once you are home, you and your support person need to be sure that your surroundings
are safe.
ξ If you have any questions or are worried about your home, call your VAD coordinator.
ξ If you do not feel safe testing your home’s electrical system, you can hire someone to do
it for you. If you have a grounded outlet, please make sure that it works before hooking
up the VAD equipment.
ξ Do not use a back up generator to power any of your VAD equipment.
ξ Avoid the strong static discharge that comes from a TV or computer screen and from
scuffing your feet on carpets. A strong static discharge can cause the VAD to stop. You
may want to spray your carpets with Static Guard®. If you keep the humidity level in
your home between 30 – 40% in the winter, you can decrease the amount of static
electricity in your home.
ξ Please minimize area rugs or tripping hazards. Please use a mat in the bathtub if used as
a shower to prevent falling if possible.

Traveling

Car Travel
ξ No driving until approved by your physician/surgeon. Until then, sit in back seat at all
times when riding in the car.
ξ Wear your seatbelt.

Airplane or Train Travel
ξ There are no restrictions for airplane (fixed wing aircraft), train or bus travel.
ξ You need your doctor’s okay before you travel via air or train.
ξ Airline or train security will need to be called.
ξ You may need documentation detailing your LVAD and its components.
ξ Plans will need to be made to have the drive console inspected by hand. It cannot go
through the x-ray machine.
ξ Do not go through the security arch but rather have them use the wand.
ξ Your VAD coordinator on call can let you know where to find the nearest VAD center to
your destination. That hospital’s VAD team may be told of the dates you will be in the
area.
ξ You will need to put the equipment in a suitcase that will fit under the seat in front of you
or in the overhead bin.
ξ Your VAD will not interfere with the radar system.

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ξ To prevent loss, you must carry on the items listed below.
o backup portable drive console AC adapter with mobility cart
o hand pump(s)
o all 8 batteries (fully charged)
o battery charger

Leaving Home

Your doctor will tell you when you can go more than a few hours away from the hospital. When
leaving home for a few hours, be sure to take these items with you.
ξ backup drive console
ξ batteries fully charged
ξ hand pumps
ξ battery charger (if staying overnight)
ξ backup mobility cart (optional)
ξ backup power cord
ξ car charger (insert into the cigarette lighter port before starting the engine)

Return To Work

You cannot return to work until cleared by your doctor.

Electronic Devices

Do not use these items within 3 feet of your device.
ξ cell phones
ξ satellite phones
ξ radio transmitters
ξ walkie talkies

Miscellaneous

Know and understand the warnings and cautions associated with having a VAD. Be sure that
you are aware of the guidelines for safe VAD function.

Phone Numbers

Call the LVAD coordinator during weekday hours of 8-4:30 at the below office numbers or by
calling paging at 608-263-6400 and ask for the VAD coordinator on call any time of day:

Margaret Murray, RN, DNP 608-262-0773
John Blabaum APNP 608-261-0962
Michele Gruenenfelder, MPA-C 608-263-4786

You may also call the Heart Failure attending on call (after hours, weekends, holidays) at
608-263-6400 with any concerns.


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If you live out of the area, call 1-800-323-8942.

Call your heart failure attending or VAD coordinator if:
ξ Any signs of infection at the driveline site (temperature over 100° F, redness, swelling,
new or different color drainage around the exit site and pain at the driveline site).
ξ New, increased, or a change in color of drainage from incision area.
ξ Unusual bruising or bleeding.
ξ Any time when you feel unwell.
ξ Any VAD concerns: alarms, questions about driveline, VAD sounds or feels abnormal, or
pain at VAD site.
ξ ER visits, if you were admitted to hospital, and are on a backup driver.
ξ Numbness, tingling, or weakness in any arm or leg.
ξ Blurred vision or speech problems.
ξ Shortness of breath or feeling dizzy.
ξ Any pain - chest pain or headaches - that will not go away.
ξ Internal implantable defibrillator fires.
ξ Weight gain of more than 5 pounds over 7 days. Any ankle swelling or changes in
waistline which may indicate water retention.
ξ Blood pressure’s top number is greater than 150 or you have multiple readings over 130 –
140.
ξ Problems with any VAD related equipment or you need replacements.
ξ Abnormal flash test or empty signal light is not flashing regularly.
ξ Flows: LVAD and RVAD flow is above or below the threshold provided. RVAD flow is
more than LVAD flow.
ξ Alarms other than battery alarms.
ξ Loss of fill light that cannot be restored using troubleshooting guide.
ξ VAD failure.


Emergency Care
Make sure 911 is available and works in your area before relying on it. Call your local fire
department if you are unsure.

Call 911 and then call your heart failure attending/VAD coordinator for any of these signs.
ξ a seizure or convulsion
ξ a loss of consciousness
ξ awake but unresponsive
ξ a sudden fall or collapse
ξ inability to talk or move body parts
ξ VAD stops

Call 911 with any signs of stroke:
ξ Changes in speech
ξ Numbness or tingling in one extremity only
ξ Weakness or unable to move one side of body
ξ Uneven smile


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An emergency occurs any time the VAD cannot pump enough blood.
ξ Loss of power to the pump
ξ Broken wires
ξ Damage to the pump motor or drive console.
ξ Health changes affecting your heart.

In emergencies, you must try to stay calm…

If the Pump is Running…
ξ Check all cable connections.
ξ Reconnect any loose cables or those that have come undone.
ξ Call 911, then the Heart Failure attending to alert us you are coming to UWHC or nearest
Emergency Department.
ξ Refer to troubleshooting guide.
ξ One family member/friend may need to ride in the ambulance with you to UWHC or
nearest Emergency Department.
ξ Make sure that emergency backup supplies are with you during your ride.

If the Pump is Not Running…
ξ First, call 911 right away and then…
ξ Refer to troubleshooting guide.
ξ Check connections, change power source, switch to back-up controller.
ξ Someone needs to call the Heart Failure attending to alert us that you are coming to
UWHC or the nearest Emergency Department.
ξ One family member/friend may need to ride in the ambulance with you to UWHC or the
nearest Emergency Department.
ξ Make sure that emergency backup supplies are with you during your ride.














Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 6/2015 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6674








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