/clinical/,/clinical/references/,/clinical/references/ed-resources/,/clinical/references/ed-resources/rn-resources/,/clinical/references/ed-resources/rn-resources/ventricular-assist-device-reference/,

/clinical/references/ed-resources/rn-resources/ventricular-assist-device-reference/

201506161

page

100

UWHC,

Patient Care,

Clinical Hub,References,Emergency Department Resources,RN Resources

Ventricular Assist Device Reference

Ventricular Assist Device Reference - Clinical Hub, References, Emergency Department Resources, RN Resources

Focus

Contact Information

  • Universal pager 0737 (paging uses)
  • VAD coordinator cell number: (608) 516-0348 (pass around phone)

I. Do’s

  1. Can assess them like any other patient except pulses will need to verified by Doppler
  2. Call VAD coordinator with any concerns
  3. CT scans, ultrasounds, CXR, KUB are acceptable diagnostic tests
  4. May externally shock or pace like a standard patient

II. Don’ts

  1. Do not do chest compressions without discussion with Heart failure team
  2. Do not take down sterile driveline dressing
  3. No MRI

Care Basics

I. Medications

  1. All are on coumadin. INR goal is variable based on patient and/or device.
  2. All are on ASA. Heartware requires 325mg. HeartMate II is usually 81mg.
  3. Pt may be on usual heart failure cocktail variety (Beta blocker, ACE inhibitor, diuretic, potassium supplement)

II. Vitals Signs

  1. Blood pressure
    1. 99.9% of patients will NOT have a palpable radial pulse
    2. BP needs to be obtained by Doppler and BP is assessed/monitored as MAP pressure = (NOT systolic)
    3. Doppler pressure
    4. Supplies: BP cuff with sphygmo + doppler
    5. Procedure
      1. Put on the BP cuff
      2. Gel on the patient's arm
      3. Turn on Doppler and find the brachial pulse (like any other pulse)
      4. Pump up the BP cuff to about 100mmHg and slowly decrease pressure
      5. First sound you hear = MAP
      6. Preferred MAP is 60-80 mmHg
  2. Heart Rate
    1. HR itself is NOT different
    2. Rhythm
      1. Can tolerate slow VT 130-170 bpm (some patients may know they have it and others do not)= maybe awake and alert and talking to you
      2. Can tolerate Afib unless really fast but usually have palpitations
      3. Still treat medically stable arrhythmias causing symptoms
      4. May treat unstable arrhythmias like any other patient- cardioversion and/or defibrillation
    3. Respiratory Rate: No change
    4. Pulse Ox- dampened waveform but should be close to accurate if finger has good circulation

III. Assessment

  1. When you listen to their chest- will hear a mechanical hum. This is normal.
  2. Mechanical hum may mask heart tones but in some patients may hear S1S2 (which means the native heart is ejecting).
  3. Can still see JVD, palpate edema
  4. Pulses by palpation are difficult (arms and feet)
  5. Abdomen- sterile dressing covering exit site of the VAD. Please do not take this down without talking with a VAD coordinator.
  6. Will see the device components

IV. Device Components

  1. Each device’s components are DIFFERENT.
  2. All have a pump (surgically implanted usually LV to aorta for LVAD)
  3. Computer- sends setting information to the pump which causes it to run
  4. Power- battery (run time is device dependent)

If you are interested in more information about your patient’s specific VAD, more information is available on uwhealth.org.

Related

Ventricular Assist Device (VAD) Resources