Download University of Kentucky Mechanic Circulatory Support Program

UNIVERSITY OF KENTUCKY
CARDIAC REHAB FOR MECHANIC
CIRCULATORY SUPPORT
PROGRAM
Mark Bradley RN
Tiya Carson PT, DPT
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
Components of the HMII
– Implantable titanium
blood pump
– System Controller
– Power Module
– Batteries & Clips
3
VAD Specific Anticoagulation
ASA 81mg
Persantine 75mg TID
Warfarin for INR target of 2.5 with
range of 2.0-3.0
VAD Specific
Hemodynamics
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
Physiological Differences
• Weak Pulse Oximetry
• Weak or no pulse
• Not accurate
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
Typical Pump Parameters
Speed 9,200 rpm (8,000 – 13,000)
Flow mean 5.5 lpm (2.5 – 10.0)
Emergent
Patient
Management
Ventricular Assist
Devices
This is an “Assistive” Device
only; not a replacement for
the Heart. If the pump fails
the patient still has native
heart function.
VAD Complications
• Right Heart failure
• Bleeding
• Arrhythmia
• Infection
• Hemolysis
• Thromboembolism
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
Defibrillation / Cardioversion
Do not stop the pump
Follow ACLS Guidelines
Controller and pump are isolated
and grounded
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.
Future of MCS: HeartWare
HeartMate III
Wireless VADs
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
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
Terminate session if:
Terminate session if:
• Dizziness, diaphoresis, or fainting
occur
• Severe, intolerable dyspnea
• Significant pain
• Extreme fatigue
• Request of patient to stop
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
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
Therapeutic Interventions
• Activity tolerance
–Aerobic activity
• Strengthening
• Core Stability
• Balance
Activity tolerance
• Goals: To increase aerobic capacity
• Options: Over-land walking, treadmills,
bicycles, upper extremity ergometer, Elliptical
machines
Strengthening
• Goals: To increase muscle mass and muscular
stability
• Options: Resistance bands, free weights, light
weight machinery
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
Outpatient Rehab
• Progress strengthening, transfers,
gait training, aerobic conditioning,
and education
• At Discharge: Should be completely
independent and functional within
the home and community
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
Questions???