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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Cardiovascular and Infusion

Mechanical Circulatory Devices (MCD) (Adult Inpatient) (1.40)

Mechanical Circulatory Devices (MCD) (Adult Inpatient) (1.40) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.40

Page 1 of 3

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
April 28, 2017

Administrative Manual
Nursing Manual (Red)
Other ______________

Policy #: 1.40A

Original
Revision

Page
1
of 3

Title: Mechanical Circulatory Devices (MCD)
(Adult Inpatient)

I. PURPOSE

A. Mechanical circulatory devices (MCD) or ventricular assist devices (VAD) are placed
in patients with severely compromised heart function. The goals of this therapy are to:
reduce myocardial workload, decompress hypokinetic ventricles, decrease oxygen
demand, and maintain adequate end organ function via improved blood flow. In
addition, MCDs can allow the patient to ambulate and maintain endurance and
mobility while awaiting cardiac transplantation. Some devices may also be used as
destination therapy, an alternate to transplant.
B. Current MCDs’ availability is determined by the cardiac surgery team. Refer to the
MCD – Adult – Inpatient/Ambulatory Clinical Practice Guideline (CPG) on U-
Connect for available devices.
C. Care related to specific devices can be found on the "Clinical Practice Guideline for
Care of the Mechanical Circulatory Device Patient" website on U-Connect.

II. POLICY

A. Pre-MCD Assessment (implantable devices primarily). Refer to MCD CPG.
B. Inpatients
1. Admitting Units and Level of Care
a. Impella MCD will be admitted to Cardiology Medical ICU (CCU).
b. Patients with Tandem Heart devices placed by interventional
cardiology should be admitted to Cardiology Medical ICU. Tandem
Heart patients placed by cardiac surgery team should be admitted to
Cardiothoracic Surgery Unit (B45).
c. All other devices will be admitted to the Cardiothoracic Acuity
Adaptable Unit (CT unit).
d. Initially, post-operative patients with an implantable MCD will be
admitted immediately to the CT unit from the OR for ICU level
of care.
e. Patients with the following MCDs will remain in ICU status until the
device is discontinued: Percutaneous MCDTandem Heart and
Impella..
2. Discharge of a MCD Patient
a. To Home: For patients able to be discharged with their MCD, refer to
the MCD CPG for further information.
i. The patient and his/her family will be competent in caring for
the device. Patient and family competence in caring for the

Page 2 of 3

device for discharge will be determined by the MCD
coordinator.
ii. A family member or patient has demonstrated the appropriate
process and technique for changing the driveline site dressing.
iii. MCD equipment is available and ready to use following
Facilities & Engineering Services Department Policy and
Procedure PE.06.20.80, Periodic Inspection of Line Powered
Equipment and UW Health Administrative (Non-Clinical)
Policy 12.63, Electric safety.
iv. Medical approval for discharge has been obtained.
3. Education of Nursing Staff Caring for these Devices
a. The CT unit (CT RN)/CCU nurses will attend an educational offering
and demonstrate competence in the following: device rationale,
operation, troubleshooting and emergency device procedures.
b. A new CT RN/CCU RN will work with an RN experienced in MCD
therapy until demonstration of competence in caring for a patient with
a MCD is established.
c. The CT RN/CCU RN must demonstrate competence in MCD therapy
annually (content to be determined by medical and senior nursing
staff).
4. MCD Assessment, Settings and Available Equipment
a. Assessment and care of the MCD must always be performed by a RN
who has demonstrated competency in MCDs.
b. All settings are determined by the attending surgeon/attending
interventionalist in consultation with perfusion, heart failure attending
or MCD Coordinator. All MCD settings will have an associating order.
C. MCD Emergency Response
1. Emergency management device dependent (see MCD CPG).
2. The emergency device failure equipment will be immediately available at all
times. (See associated MCD CPG.)
3. NO chest compressions should be performed unless directed by the cardiac
surgery or cardiology attending physician.
4. Defibrillation: Please see MCD CPG for device specific instructions.

III. UWHC CROSS REFERENCES

A. Clinical Practice Guidelines: Mechanical Circulatory Device (MCD) – Adult –
Inpatient/Ambulatory (on U-Connect)
B. Clinical Practice Guideline for Care of the Mechanical Circulatory Device Patient
Website (on U-Connect)
C. UWHC Administrative Policy 7.19, Admission & Discharge Criteria for ICU Status
on the Cardiothoracic Surgery and Transplant Unit (Acuity Adaptable Unit)
D. UWHC Administrative Policy 7.50, Admission & Discharge Criteria for IMC Status
on the Cardiothoracic Surgery and Transplant Unit (Acuity Adaptable Unit)
E. Facilities & Engineering Services Department Policy and Procedure PE.06.20.80,
Periodic Inspection of Line Powered Equipment
F. UW Health Administrative (Non-Clinical) Policy 12.63, Electric Safety



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IV. REVIEWED BY

Assistant Director, Surgical Services
Clinical Nurse Specialist, Cardiac Surgery
Nurse Practitioner, Ventricular Assist Device
Nursing Patient Care Policy and Procedure Committee, April 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive