Download Ventricular Assist Device Overview

Permanent Ventricular Assist Device Systems
What are Ventricular Assist Devices (VAD)?
VADs are mechanical heart pumps that help the heart work. They are implanted surgically.
What do they do?
A VAD takes over the pumping action of one or both of the bottom chambers of the heart. These
chambers are called the ventricles. The right side provides blood flow to the lungs. The left side
provides blood flow to the rest of the body. Two VADs may be placed to help both sides of the
heart.
Why are they used?
They are used for patients whose hearts are too weak to maintain enough blood flow to the body.
They may be used as a:
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Bridge to transplant. These patients are on the waiting list for a heart transplant.
Destination therapy. These patients are not candidates for a heart transplant. They will
have the VAD for the rest of their lives.
What daily care is needed?
Care of the VAD depends on the exact device. Basic care includes:
 Changing the sterile dressing to the driveline daily.
 Keeping a record of VAD numbers daily.
 Changing power sources.
 Maintaining the batteries, clips, and other equipment.
What are the activity restrictions?
 No driving until approved by your doctor or surgeon. Sit in the back seat to prevent
possible trauma to your chest bone from airbags or the dashboard.
 No heavy lifting of more than 10 pounds for 6-8 weeks. Then, your doctor will decide
how much you can lift.
 No tub baths. You may shower with the use of a special method once your wounds are
healed and with your surgeon’s approval.
What is involved in the hospital stay and the return to your home?
Most patients stay in the hospital for 7-14 days. You will be in the cardiac surgery intensive care
unit for 1 to 2 days. For most patients, you and your family or friends will begin learning about
the VAD the day after surgery. You will learn how to care for the device and how to handle an
emergency after you go home. You will need 1 or 2 support people to help you. One person will
need to learn how to do the sterile dressing changes. This person will have to show that they
know how to do the sterile dressing change before discharge.
You may need to stay in a local hotel for a time if you live more than 30 minutes away from the
hospital or if your medical team decides this is best. The hotel stay is often 2-3 days. This hotel
stay allows you and your family to get used to living with the VAD before going home. A social
worker can help you arrange this. A member of your support team will need to stay with you
during this time. You will have at least one clinic visit before going home.
While you are at the hospital, the VAD coordinator will be in contact with your local community
support agencies such as emergency medical services (EMS), local hospital, electrical company,
and cardiac rehab. They will be given details about the VAD. A plan will be made in case of an
emergency. This must be set up before your return to your home. If you have questions about
this, please contact a VAD coordinator. Once you go home, a support person should be with you
at all times for at least 2 weeks or as patient’s condition allows.
Clinic visits start out very often (every 1 to 2 weeks) and will become monthly visits. Over time,
the clinic visits should be farther out based on how you are doing. You may need to have your
lab work done more often, but this can be done at your local lab or clinic.
How Is My VAD Chosen?
UWHC implants many devices. The device will be chosen using the standards below.
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The patient’s body size.
If support is needed for one or both ventricles.
Patient health history.
If a newer trial device would be best.
Insurance approval.
The surgeon will meet with you and discuss these options to decide which device will be placed.
Trial devices are those in clinical trials by the Federal Drug Administration (FDA). There are
special standards that need to be met to be enrolled in a trial. Special research tests may be
needed. If you are going to be screened for one of these devices, you will be contacted by a
Research Coordinator.
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What are the basic types of FDA approved VADs implanted at UWHC?
HeartMate II Left VAD
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HeartMate II LVAD is a constant flow pump that diverts
blood from the left ventricle and pumps it into the aorta.
The pump connects to a controller or ‘brain’ by a driveline.
The driveline comes from the upper abdomen. The
controller connects to a power source. The power source
can be battery or an electrical wall outlet. The pump must
be connected to a power source at all times.
It requires the use of blood thinners and aspirin daily.
You will not be able to monitor your blood pressure or
pulse at home.
The controller has a back-up built into the unit. HeartMate
II LVAD is approved for bridge to transplant and
destination therapy patients.
Heartware HVAD
 Heartware LVAD is a constant flow pump that
diverts blood from the left ventricle and pumps it
into the aorta. The pump connects to a controller or
‘brain’ by a driveline. The driveline comes from the
upper abdomen. The controller connects to a power
source. The power source can be battery or an
electrical wall outlet. The pump must be connected
to a power source at all times. It is approved only
for bridge-to-transplant patients.
 It requires the use of blood thinners and aspirin
daily.
 You will not be able to monitor your blood pressure
or pulse at home.
What to Expect (Patients)
We ask that you commit to the items below in order to take care of yourself.
1. I will have at least 2 support persons.
2. Treatment Plan: I will follow the treatment plan prescribed by my doctors. If I have
any concerns about the plan, I will talk with my doctors. I understand they will adjust the
plan as needed.
3. Communication: I will be open, honest, and cooperative with all members of my
treatment team. I will contact my nurse coordinator with any health concerns.
4. Daily Self Cares: I will make sure my drive line dressing is changed daily or as I was
told using the proper technique. Once the dressing supply company is set up, I will
contact that company and call in for new shipments. I will learn to check and record my
temperature, weight and VAD readings. I will take care of my VAD. This includes
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changing batteries, making sure it is working as it should, troubleshooting alarms and
telling my VAD coordinator of any concerns or questions.
5. Medicines: I will learn to give myself my medicines. I will take all prescription
medicines as prescribed. I will not take any substance, herb, over the counter medicine,
or other medicines not prescribed by my doctors without talking with the VAD
coordinator or heart failure team.
6. Substance Abuse: I will not smoke, drink alcohol or use recreational drugs.
7. Activity: I will follow activity guidelines prescribed by my doctors. I will follow an
exercise plan such as cardiac rehab approved by my doctors. I know that I may not drive
without permission from my surgeon and other doctors.
8. Diet: I will follow the diet guidelines the nutritionist gave me. I will follow the fluid and
salt limits prescribed by my doctors. I will work towards and maintain a healthy weight
as prescribed by my doctors.
9. Appointments: I will keep my clinic appointments. If I need to reschedule a visit, I will
give 48 hours’ notice except for emergencies. I know my clinic visits may start as
weekly, decrease to monthly, and then are every 6 weeks. I know that clinic visit times
may not always be at a time that works best for me. I know that I need to arrange
transportation to and from visits.
10. Education: I will attend teaching sessions after I get my VAD. I will read the
educational materials given to me by the team. I will ask questions about anything I do
not understand. I will let my VAD coordinator know if I need to review any of the topics.
I will take an active role in learning about my device and the care of it.
11. Finances: I know I am responsible for the costs of my care. If my insurance changes, I
will let my heart failure social worker or VAD coordinator know as soon as I can.
12. Local Housing: I know that my primary support person and I will need to stay within 60
minutes of UW Hospital for about 2-3days after discharge. I know I will need to cover
the cost of my housing. I know that if I am not able to pay for my housing I need to let
my social worker know as I can. I know at times I may also need to stay in Madison
overnight as told by my doctors.
13. Pets: Pets should not have access to the VAD equipment such as batteries, wires, and
consoles. Pets should not jump on my chest or chew on the driveline or cables. Pets
should be out of the room during dressing changes. If I have a cat, I will clean the litter
box. If I have a bird, I will clean the birdcage.
What to Expect (Support Person)
1. After the LVAD is implanted, a support person needs to be present to learn about the
device, how to care for it, manage alarms and be a resource for the patient after discharge.
This teaching is done most days of the week to allow repetition to help in learning.
2. Education: I will attend classes after surgery during the patient’s inpatient recovery.
Education may start on POD 1 after surgery and is every weekday until discharge. The
session can be varied. It will depend on my learning needs and the needs of the patient.
3. Local housing: When the patient is discharged after VAD surgery, someone trained on
the VAD equipment will need to stay with the patient 24 hours a day in the Madison area
for at least 2-3 days. It depends on how the patient does.
4. Appointments: I will transport the patient to and from clinic appointments and will be at
the appointments if told to by the team. These include scheduled and emergency clinic
appointments.
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I know visits may start as weekly, decrease to monthly, and then are every 6
weeks. I know clinic visit times may not always be at a time that works best for
me.
 I know outpatients may also need to come to UW Hospital in Madison or their
local hospital or clinic daily after VAD placement for labs, chest x-rays, therapies,
and education.
5. Personal Care: I will do personal cares for patient as needed. This may include helping
with dressing changes using the proper technique, giving medicines, monitoring VAD
readings and assessing for proper function, and helping with personal hygiene. I will
troubleshoot any alarms with the patient and contact the VAD coordinator with any
questions or concerns.
6. Pets: Pets are wonderful members of the family. Pets should not have access to the VAD
equipment such as batteries, wires, and consoles. Pets should not jump on the patient’s
chest or chew on the driveline or cables. Pets should be out of the room during dressing
changes. If a patient has a cat, I will clean the litter box. If the patient has a bird, I will
clean the birdcage.
References
Web sites that may be helpful.
www.thoratec.com
www.heartware.com
www.americanheart.org
www.nlm.nih.gov
Please let us know if you have questions.
Your VAD coordinators:
Margaret Murray, RN, DNP
John Blabaum, RN, APNP
Crystal Sheehan RN, MSN
Leann DeRungs, RN, APNP
608-262-0773
608-261-0962
608-265-7134
608-263-4786
Images Reprinted with permission from Thoratec Corporation
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 © 5/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6681
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