University of Kentucky Cardiac Rehab for Mechanic Circulatory Support Program

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University of KentuckyCardiac Rehab for Mechanic
Circulatory Support Program

• Mark Bradley RN
• Tiya Carson PT, DPT

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Objectives

• Understand the precautions used with mechanical
  circulatory devices and rehab intervention

• Discuss appropriate treatment plans for clients
  with mechanical circulatory device

• Discuss appropriate education to clients and
  families regarding activity level and community
  outreaches

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Components of the HMII

• Implantable titanium blood pump

• System Controller

• Power Module

• Batteries Clips

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VAD Specific Anticoagulation
ASA 81mg Persantine 75mg TID Warfarin for INR
target of 2.5 with range of 2.0-3.0
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VAD Specific Hemodynamics
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Physiological Differences

• Weak or absent Pulse!
• Most patients will not have a pulse
• The ventricle is unloaded before enough pressure
  is generated to open the aortic valve

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Physiological Differences

• Weak Pulse Oximetry
• Weak or no pulse
• Not accurate

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Physiological Differences

• Blood pressure
• will have a narrow pulse pressure
• Most patients do not have a audible blood
  pressure
• Need to use Doppler
• Measure the MAP

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Typical Pump Parameters

• Speed 9,200 rpm (8,000 13,000)
• Flow mean 5.5 lpm (2.5 10.0)

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EmergentPatient Management
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Ventricular Assist DevicesThis is an Assistive
Device only not a replacement for the Heart. If
the pump fails the patient still has native heart
function.
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VAD Complications

• Right Heart failure

• Bleeding

• Arrhythmia

• Infection

• Hemolysis

• Thromboembolism

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Initial Assessment
Treat the patient not the equipment
Follow ACLS Guidelines
Treat dysrhythmia only if symptomatic
Dysrhythmias can effect pre-load VAD Flows
Treat the symptomatic VAD as a Heart Failure
Patient
OK to use Inotropes presser's as needed
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Defibrillation / Cardioversion
Do not stop the pump
Follow ACLS Guidelines
Controller and pump are isolated and grounded
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Chest Compressions
Is the patient Pink, Warm and Dry or blue?
Listen to Apex of Heart for humming sound to
verify is pump is running
If the controller is not alarming and no red
lights, no alarms then the pump is running
When in doubt about the performance of the pump
or if the patient appears to be symptomatic, do
chest compressions.
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Future of MCS HeartWare
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HeartMate III
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Wireless VADs
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LVAD Precautions

• Sternal Precautions (4-6 weeks)
• Secure all parts
• No overly vigorous activity
• Monitor Vital Signs
• Monitor Tolerance
• Rate Perceived Exertion Scales (Borg)
• Dyspnea Scales

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HeartMate II Alarms

• Intermittent beep Cautionary audible alert
• One battery is disconnected
• Time to change batteries or return to Power Module

• Continuous blaring sound either pump has stopped
  or pump flow is greatly reduced.
• Both power sources are disconnected
• Pump failure
• Low Systemic Volume

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Terminate session if
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Terminate session if

• Dizziness, diaphoresis, or fainting occur
• Severe, intolerable dyspnea
• Significant pain
• Extreme fatigue
• Request of patient to stop

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Treatment Precautions for MCS

• Patient/ family must have all supplies for rehab
• Do NOT initiate treatment if
• Back-up device
• Batteries
• Back-up batteries
• Nitro
• Are not available

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Treatment Precautions for MCS

• Blood pressure
• If you are not able to get a blood pressure this
  is not necessarily a contraindication to
  treatment
• LVAD you are effectively reducing the load to
  the ventricles
• TAH blood pressure is accurate
• Assess the patient
• Should be pink, dry, and mentating

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Therapeutic Interventions

• Activity tolerance
• Aerobic activity
• Strengthening
• Core Stability
• Balance

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Activity tolerance

• Goals To increase aerobic capacity
• Options Over-land walking, treadmills, bicycles,
  upper extremity ergometer, Elliptical machines

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Strengthening

• Goals To increase muscle mass and muscular
  stability
• Options Resistance bands, free weights, light
  weight machinery

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Core Stability and Balance

• Goals retrain key support muscles that were
  possibly affected from surgery to gain maximum
  functional mobility
• Options balance balls, foam rollers, Bosu balls,
  mat work, Yoga, Pilates, Tai Chi, Wii fitness,
  stretching

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Outpatient Rehab

• Progress strengthening, transfers, gait training,
  aerobic conditioning, and education
• At Discharge Should be completely independent
  and functional within the home and community

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Education

• Patients should be doing as much as they can!!!
• Walking everyday
• Participate in Rehab Program
• Getting out of the home and back into community
• Families should encourage activity
• No swimming or submersion underwater
• No vigorous/ jarring

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• Questions???