Community Preparation for Caring for Mechanical Circulatory Device Patients

1
Community Preparation for Caring for Mechanical
Circulatory Device Patients

• University of Wisconsin Hospital
• And Clinics
• Ventricular Assist Device Program

2
Mechanical Circulatory Support Device Overview

• MCDSs are devices to support the failing heart
  (one side or both)
• Most MCDS patients are anticoagulated with
  Coumadin and Aspirin
• All MCDSs have
• Pump (implanted inside the patients chest)
• Computer to control the settings/ display VAD
  performance readings
• Power source batteries or console connected to
  AC power

3
Heartware HVAD Components
Small pump attaches directly to heart
Thin, flexible driveline cable exits skin
A small controller batteries run the pump
4
Heartware HVAD Readings

• 3 Readings
• Flow cardiac output from the pump
• Target varies by patient
• Speed how fast pump is running rpm
• - range 2400-3200 rpm
• Power how much watts it takes to run the pump
• - normal is lt 8 watts

5
Heartware HVAD Care Overview

• Cannot palpate a pulse
• Pulse oximeter may/ may not work
• Need to assess if pump is running listen over
  the point of maximal impulse (PMI) area for a
  consistent mechanical hum
• Blood pressure need a Doppler and
  sphygmomanometer
• result is considered a MAP
• acceptable MAP 60-85 mmHg

6
Heartware HVAD Care Overview

• EKG conduction-looks normal
• does not impact VAD function unless RV fails
• VAD will continue to receive blood supply until
  RV fails or pulmonary hypertension
• Most of these patients have an ICD/ pacer. Some
  patients ICDs are off to avoid inappropriate
  shocks.
• Most VAD patients tolerate the arrhythmias well
  and may have little symptoms for period of time.
• Assess for patients tolerance of situation (if
  able). Ask for symptoms lightheadedness,
  shortness of breath, palpitations, bloating, pain
  (anywhere), fever, chills, diaphoresis

7
Heartware HVAD Controller Faceplate
8
EMERGENCY CARE

• Call implant hospital 608-263-6400 and ask for
  HEART FAILURE ATTENDING ON CALL
• Still need to follow Airway Breathing of ABCs
• v VAD stopped (listen over PMI area for
  consistent mechanical hum). If stopped
  significant risk for clot inside MCDS and
  thromboembolize.
• No chest compressions
• Defibrillation- STANDARD METHOD
• Heparin bolus if VAD stopped (contact implant
  hospital first)

9
Contacts

• 608-263-6400 (Paging Operator)
• Heart Failure Attending
• Ventricular Assist Device Coordinator
  (non-emergency)