Download Left ventricular assist device (LVAD) - Feb 2011

Royal Brompton & Harefield
NHS Foundation Trust
Left ventricular assist
device (LVAD)
Information for patients
Contents
What is a left ventricular assist device?
The types of LVADs at Harefield Hospital
Is an LVAD a suitable treatment for me?
What are the benefits of the LVAD operation?
Are there any alternatives to the operation?
What will happen if I don’t have the operation?
What are the risks of the operation?
The operation
Where can my family wait during the operation?
Recovery in hospital after the operation
What will I feel like when I’m in intensive care?
Can my friends and family visit me while I am in
the ITU?
What else will happen when I am in intensive
care?
What will happen when I move back to the
transplant ward?
What is the transplant unit like?
How will I feel emotionally after the operation?
Going home
Wound care
What if I have problems when I am at home?
What should I do in the event of an emergency?
Lifestyle
Who can I contact for further information?
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This booklet is a general guide about having a left ventricular
assist device (LVAD) fitted as a treatment for heart failure. It
does not replace the information and individual advice we give
you in person. Please ask if you have any questions about this
booklet.
What is a left ventricular assist device?
A left ventricular assist device (LVAD) is a pump that is
attached to the heart helping it to circulate blood around the
body. It works by sucking the blood from the main pumping
chamber of the heart (the left ventricle) and pumping it into
the main artery (aorta), which carries blood to all parts of the
body. An LVAD can help where a patient’s heart is not working
well enough to pump blood through the body.
What are LVADs used for?
LVADs can extend the lives and improve the health of patients
with advanced heart failure. Most patients find that they have
fewer symptoms, find exercising easier and that their quality
of life improves.
An LVAD can be used:
• as a bridge to transplantation – so we can try to make sure
the patient is well enough for heart transplant surgery in
the future, or
• as a bridge to recovery for some patients with certain types
of heart disease. An LVAD can help the heart to rest and
recover enough so that a transplant is no longer needed and
the LVAD can be removed. However, it is not possible to
predict or guarantee that the heart can recover.
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Unfortunately, it is not possible to guarantee that an LVAD can
be removed once it has been fitted. Even if we suggest that
the patient should have a heart transplant, we cannot
guarantee that a suitable heart will become available. The
patient may also develop a complication that can make a
transplant very difficult or risky. Patients should understand
and accept that the LVAD could become a long term therapy.
The types of LVADs at Harefield Hospital
At the time of writing (February 2011), we are using two types
of LVAD: the HeartMate II and the HeartWare HVAD. However,
other devices are likely to become available in the near future.
Please note that most of these devices work in a similar way. If
you need more information about a specific device that has
been suggested for your treatment, please ask your VAD nurse
or surgeon.
The HeartMate II
The image below shows how the HeartMate II will be placed in
your body.
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The HeartMate II pump has a propeller that spins around to
circulate the blood. The pump is connected to wires, called a
driveline, which exits through a small cut in the skin of the
abdomen. The driveline connects to a system controller that is
worn on a belt. The system is powered by a pair of
rechargeable batteries or by a mains electricity appliance for
night time use.
The HeartMate II Power module
The HeartMate II Power
module provides power to the
device while you are sleeping
(A/C mains electrical power).
It also provides power to a
display screen to show you
how the pump is working.
The power module amplifies
the alarms when you are
sleeping and it contains a
back up battery in case of a
power cut.
The HeartMate II battery charger
The HeartMate II battery
charger is designed to
charge the batteries that
are used to power your
device. It can charge up to
four batteries in
approximately four hours.
You will have at least four
batteries to take home
with you.
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HeartWare HVAD
The HeartWare pump rests inside your chest and two small
motors inside the pump move the propeller that circulates the
blood. The pump is connected to wires, called a driveline,
which exits through a small cut in the skin of the abdomen.
The driveline connects to a system controller and batteries that
are worn on a belt or in a bag (see image below).
HeartWare controller
The controller operates your
pump and makes sure that it is
working correctly. The
controller is connected to your
driveline and must have two
power supplies, either two
batteries or mains power and a
battery. The display on the
controller gives information about how the pump is
performing. This includes the blood flow through the pump
(L/min), speed of the propeller (rpm) and the amount of
power used (watts). The controller also warns you if there
is a problem with your pump or with the power supply.
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HeartWare battery charger
The battery charger is used to
charge up to four batteries
and it takes around four to
five hours to charge them
fully. You will have at least
four batteries to take home
with you.
Is an LVAD a suitable
treatment for me?
We have to do a number of tests before we can decide if you
need an LVAD. Some of these tests may be repeated after you
have received your LVAD to help monitor your progress.
Tests are also needed to decide whether LVAD surgery is likely
to be successful and if a heart transplant is likely to be possible
in the future. You can read about tests for transplantation in
our booklet Heart failure and transplantation.
Here are some of the tests we commonly use:
Electrocardiogram (ECG)
This painless test only takes a few minutes and shows the
rhythm and electrical activity of your heart. It involves placing
small sticky patches (electrodes) on your arms, leg and chest
that are connected by leads to an ECG recorder.
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Echocardiogram (ECHO)
This is a simple and painless ultrasound scan of the heart that
takes up to 30 minutes to complete. It allows us to learn more
about the structure and function of your heart valves and
heart chambers. After the LVAD has been fitted, we may carry
out several ultrasound scans with the pump speed set lower
than normal. This means that your heart has to pump more
blood and allows us to test how well your heart is working.
Chest x-ray
This is a simple test that provides an image of your lungs and
heart.
Cardiac catheterisation (also known as an angiogram)
A cardiac catheterisation is a special x-ray investigation. It
involves making a small needle hole (under local anaesthetic)
in your groin or neck through which a small, hollow, flexible
tube called a catheter is inserted. The catheter is guided into
the artery or vein and then through the blood vessels into the
heart. Once the catheter is in the correct place pressures will
be measured. Contrast may be injected through it into the
heart and a series of x-ray pictures are taken.
We have a separate leaflet on cardiac catheterisation. If you
would like a copy, please just ask a member of staff.
Some patients who have a high blood pressure in their lungs
may need a longer cardiac catheterisation procedure, where
drugs are given intravenously, to determine whether the
pressure can be reduced.
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Multiple gated acquisition (MUGA) scan
This scan takes about 45 minutes and looks at how much blood
your heart is pumping out. We will give you two injections
before the scan. The first injection contains a substance that
identifies your red blood cells.
The second injection is the tracer, a substance with a small
amount of radioactivity. It attaches to the red blood cells and
enables us to see the blood flowing through the heart using a
special camera. The amount of radioactivity used in MUGA
scans is kept to an absolute minimum and we strongly believe
that the benefits of the scan outweigh any risks.
We have a separate leaflet available on having a MUGA scan.
Please ask if you would like a copy.
Blood tests
We use blood tests regularly as they give us a lot of necessary
information. If you are not sure why a blood sample is needed,
please ask one of the staff members responsible for your care.
Respiratory function test
This test measures how well your lungs are working. It is quick
and painless and involves blowing into a tube as quickly as you
can.
Cardiopulmonary exercise test
We use this test during the assessment for an LVAD and again
after the device has been fitted. This is so we can understand
how well your natural heart can handle exercise. We will ask
you to walk on a treadmill for as long as possible while we
monitor your heart rhythm and your breathing.
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After the LVAD has been fitted, the first part of the test is
carried out with the LVAD turned on at full speed. The same
test is then carried out a few hours later with the LVAD speed
turned down. This lets us see how well your heart can work
with less help from the LVAD.
Cardiac magnetic resonance (CMR) scan
A CMR scan is used when we want detailed pictures of the
heart and blood vessels and how they are working. You will be
asked to lie on a bed that will move slowly through the
scanner. The scan uses strong magnetic fields and radio waves
to produce the images. If you have any metallic devices or
implants you cannot have this scan as the scanner contains a
large magnet.
Computed tomography (CT) scan
A CT scan is a special kind of x-ray where several beams are
sent at the same time from different angles to produce the
scan. CT scans are more detailed than a normal x-ray and can
produce 3D images of your body. We may have to give you a
tracer injection before a scan where we need to make the
blood vessels easier to see.
You will be lying flat on a bed that will move slowly through
the scanner. You may be asked to hold your breath for a few
seconds while the scans are taken. This scan may be done
again after an LVAD has been fitted so that we can see the
position of your device, helping us to plan any future surgery.
What are the benefits of the LVAD operation?
An LVAD takes over the function of pumping blood from the
left side of a heart that is failing to work properly.
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After the procedure, you should find that the symptoms of
heart failure (such as feeling breathless, coughing, swelling in
your ankles and feeling tired) either go away or become much
less troublesome.
Most patients find they can return to many normal daily
activities. Modern LVADs are quite small and function almost
silently, so there are only a few restrictions on what you can do.
Are there any alternatives to the operation?
If we are discussing an LVAD with you it is because your heart
failure is serious and we believe that drugs alone cannot give
your heart the help it needs.
There are two reasons why we may be considering an LVAD for
you. This is either because your heart failure has made your
current medical condition unsuitable for a transplant or
because we do not think that you will be able to wait long
enough for a heart transplant to become available.
What will happen if I don’t have the operation?
This depends on your current condition and how severe it is.
However, without surgery, your heart failure and health may
get worse. Ultimately, your heart condition may get to the
point where your heart is no longer able to keep you alive.
What are the risks of the operation?
It is important to know that all surgical procedures carry some
risk and that the risks for LVAD implantation are greater than
for most other kinds of heart surgery.
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However, it is important to remember that we would not
recommend this operation if we did not believe the likely
benefits to your health would outweigh these risks.
Your surgeon will explain the risks that apply to you, but some
of the most common risks of LVAD surgery include:
Bleeding
All heart operations carry a risk of bleeding. The risk of
bleeding after the LVAD has been fitted is high compared to
other heart operations. Occasionally a second operation is
needed to eliminate the source of bleeding.
You are also more at risk of bleeding immediately after the
operation as we will give you anti-coagulant medicine to
reduce the risk of you developing blood clots inside the LVAD.
We keep a close eye on this by giving you regular blood tests
to make sure your blood is not too thin. These tests will
continue once you are back at home. LVAD patients also have
an increased risk of internal bleeding into the digestive system
and elsewhere.
Kidney problems
There is a risk of kidney failure because of your underlying
heart failure and the complex LVAD operation. If this happens,
you may need support from a type of kidney dialysis machine
(haemofiltration), which is usually only temporary.
Infection
When you have an LVAD in place, it is possible for bacteria to
get into your body where the driveline lead comes out
through your skin. If you do get an infection here, it can be
treated with antibiotics but it can be difficult to cure
completely. Occasionally an infection can spread to the LVAD
itself and this may need to be treated with further surgery.
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Infection is one of the most serious complications of LVAD
therapy. Although infection can be treated, it is usually not
possible to cure a deep seated infection while the LVAD is in
place.
Driveline care is extremely important to reduce the risk of
infection. There is more detailed information about wound
care on page 25 of this booklet.
You will need to keep a dressing over the exit site to protect
you from infection. We will always keep a close eye out for
signs of infection and encourage you to do the same. If you
develop an infection, we will treat it with antibiotics.
Stroke
A stroke is an uncommon, but serious complication of LVAD
treatment. It occurs when the supply of oxygen to the brain is
interrupted, causing the brain cells to become damaged or die.
Occasionally the damage is minor and the effect is temporary
but in some cases, the damage can be permanent. Similar
problems may be caused by bleeding into the brain tissue.
Death
Having an LVAD fitted is a major operation and it does carry a
risk of death. According to our experience there is a 15% risk
of death within 30 days of the procedure. Our survival rates
are described at the end of this booklet. The risk will vary from
patient to patient and your surgeon will discuss your
anticipated risk with you when he or she asks you to sign the
consent form for the operation.
The need for a right ventricular assist device (RVAD)
The LVAD only provides direct assistance to the left side of
your heart. Occasionally it is necessary to support the right side
of the heart with an RVAD in addition to LVAD support.
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If it is likely that you may need an RVAD, your surgeon will
discuss this with you. Sometimes the need for an RVAD only
becomes apparent during your operation. In the majority of
cases, this would be a temporary measure and the RVAD
would be removed once the right side of your heart has
stabilised. In the event that you need long term right sided
support, your surgeon will discuss the options with you. The
need for right sided support increases the overall risk of the
operation. Unfortunately, there is not always a satisfactory
solution to the problems caused by right ventricular failure.
The short term device that we use for right sided support is
called a Levitronix. This is an external device and the lines
containing the blood will be outside your body. A propeller,
which is suspended by a magnet, then pulls your blood
through these lines.
A patient with a Levitronix device
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The operation
What happens before the operation?
Before the operation, different members of our team will visit
you to discuss their specialist areas of the procedure.
Your consultant cardiologist will explain more about your
condition and how the LVAD is expected to help you.
The anaesthetist will talk to you about what happens during
the anaesthetics procedure for the operation and will ask you
about any previous anaesthetics you may have had. The
anaesthetist will make sure you are doing well during the
procedure and will manage any pain you may experience.
Your surgeon will explain what is going to happen during the
procedure and answer any questions you may have. They will
then ask you to sign a consent (agreement) form, which shows
that you agree to have the operation.
One of the artificial heart team will talk to you in more detail
about the LVAD device that has been selected for you and will
give you advice about living with an LVAD.
You will have a chance to ask our specialist staff any questions
you may have.
Immediately before the operation, we will take you to the
anaesthetic room where the anaesthetist will give you a
general anaesthetic. This will ensure that you are unconscious
and pain free during the operation. Once you are fully asleep
and attached to the monitoring equipment, we will move you
into the operating theatre for the procedure.
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What happens during the operation?
To insert the LVAD, the surgeon makes a cut from your
breastbone to your abdomen. The chest is then opened to
reveal the heart. The surgeon connects one tube from the
LVAD to your left ventricle and the other to your aorta. Once
they are both in place, the power lead is passed out of your
body through a small hole made in the skin of your abdomen.
Most patients will be on a special heart-lung bypass machine
during the operation. This takes over the job of your heart and
lungs and pumps blood around your body. The bypass machine
is necessary as your surgeon usually has to stop your heart to
connect the LVAD.
During your operation and immediately afterwards, you will
be attached to some essential medical monitoring equipment
that normally includes:
• a probe on your finger to measure your pulse and the
amount of oxygen in your blood
• sticky patches (electrodes) on your chest to monitor your
heart rhythm
• a catheter in your bladder to measure how much urine your
kidneys are producing
• several tubes coming out of your chest and abdomen,
known as drains to ensure that fluid is not collecting inside
your body and to check if you are bleeding
• an arterial line (tube in one of your arteries usually at the
wrist) to check your blood pressure
• a central line (a tube placed into a vein in the neck) to give
you medication and check your fluid levels
• an endotracheal tube (a tube inserted in your windpipe) to
ensure that air reaches your lungs when you are connected
to the mechanical ventilator.
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Where can my family wait during the operation?
Your friends and family are welcome to stay in the hospital
while you are having your operation. They can wait in the
relatives’ area just outside the intensive care unit (also known
as ITU) or in the hospital restaurant. It is important that they
know the procedure usually takes between five to eight hours
and can sometimes take longer. The nurse looking after you
can contact your relatives when the operation has finished.
Recovery in hospital after the operation
What happens after the operation?
After the operation, we will take you to the ITU where you
will stay until you are well enough to go back to the
transplant ward. The time it takes varies for each patient.
Some patients stay in the ITU for a few days, while others can
stay for a few weeks before they are well enough to move
back to the transplant ward.
Help with breathing
At first you will be asleep or very drowsy. You will be attached
to a ventilator, a machine that helps you to breathe. The
ventilator tube is placed in your mouth and down your
windpipe. You will not be able to talk, eat or drink while on
the ventilator. As soon as your condition is stable, we will
reduce the sleep medication and remove the breathing tube so
you can start breathing for yourself. You will soon be able to
speak and in time, you will be able to drink.
Help with feeding
Until you are well enough to drink for yourself, we will give
you water through a drip in one of the large veins in your
neck. We will give you food by nasogastric tube, which is
inserted into your nostril and passed down into your stomach.
We can also use these tubes to give you medication.
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Help with passing urine
You will have a catheter in place to drain the urine from your
bladder. This means that you do not have to worry about
going to the toilet and also lets us check how much urine you
are producing.
Help with draining excess blood from the surgical site
There will be at least two drains from your chest helping to
remove the blood and fluid that collects within your chest
after surgery. One end of a tube is placed in your chest and
the other end into the chest drain bottle. The tube is held in
place with a stitch (suture) and is placed between the ribcage
and the lung. We will remove the drains once any bleeding has
slowed down.
Help with controlling your heart rate
Sometimes the heart beats slowly after an LVAD has been
fitted. When this happens, we can regulate the heartbeat
using a pacemaker. This means you may have thin wires
coming from your chest for the first few days after your
operation. We will remove these as soon as your heart beats
normally again.
What will I feel like when I’m in intensive care?
It is worth knowing that most patients do not remember much
about their time spent in intensive care. This is because of the
medication we give you to keep you drowsy and free from
pain after the operation. We will help you to manage your
pain after the operation. You will initially receive intravenous
(directly into the vein) pain medication, which will change to
tablet painkillers once you are fully awake. Some patients may
suffer from hallucinations during this time. The hallucinations
will become less frequent and less vivid over time. If you
experience hallucinations, please let us know.
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Can my friends and family visit me while I am in the
ITU?
We ask that only immediate family visit you in the ITU and
that you only have two visitors at a time. This is to allow
medical and nursing staff to carry out your care and treatment.
Your friends and family are welcome to use the nearby waiting
rooms.
We recommend that you choose one key person in your family
to share information on your progress with other family
members and friends. This will provide us with a clear channel
of communication.
What else will happen when I am in intensive care?
A physiotherapist will visit you regularly while you are in the
ITU. The physiotherapist will make sure your lungs are working
well and check the movement in all your joints. Once you
come off the ventilator, you will learn techniques to help you
take deep breaths and clear any phlegm (thick mucus) that you
may have on your chest.
As soon as you are well enough, the physiotherapist will help
you to get out of bed and sit in a chair. Even though you may
still have lines and drains in place, this will not stop you from
getting out of bed. Getting up will help your muscles work
more normally and help your lungs work more effectively.
Once you are able to get out of bed safely, your physiotherapist
will give you some exercises to do. These will stop your joints
from becoming stiff and help your muscles work properly.
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What will happen when I move back to the
transplant ward?
We will move you from the ITU to the transplant ward when
you are well enough. You will still be attached to a cardiac
monitor to check your heart rate and rhythm, have a urinary
catheter in place and may still have chest drains and/or drips.
We will start to remove these as your condition improves.
The VAD team and ward nurses will look after all your LVAD
equipment. As you get better, we will show you and your
family how to look after the device and deal with any
problems. You and your family members/friends will need to
complete a quiz to make sure you know how to look after
your LVAD and how to deal with emergency situations. The
VAD team will explain this to you and will go through the
questions with you. If you are unable to complete the quiz or
perform the emergency procedures, you will need to have
someone with you 24 hours a day who has been trained to
help you.
What is the transplant unit like?
While you are in the ITU, a single nurse will care for you.
However on the transplant unit, each nurse cares for several
patients. This may take some getting used to, but please
remember that being back on the transplant unit is a sign that
you are beginning to recover from your operation. All the
rooms in the transplant unit are single rooms with TVs,
phones, fridges and washbasins. Showers and toilets are in a
central section of the ward.
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Will I still see the physiotherapist?
Physiotherapy is a very important part of your recovery and a
physiotherapist will continue to see you regularly once you are
back on the ward. Once most of your lines and drains have
been removed, they will help you to start walking. You will
start with very short distances at first and as your confidence
grows, you will be able to walk further.
Your physiotherapist will also design a personal exercise
programme for you. This will help to make you as independent
as possible and fit enough to go home safely.
How will I feel emotionally after the operation?
Every patient reacts differently to having an LVAD operation.
There is no right or wrong way to feel. Many patients feel very
happy and relieved after surgery but some may have periods
of feeling low or down.
Most patients experience a time where they feel worried
about their recovery, have concerns about looking after their
LVADs or have practical worries about going home.
Your emotional wellbeing is as important as your physical
recovery and we will support you through these mixed
emotions. Do not hesitate to talk to us. We are always on hand
to help and can refer you to our health psychologists if you
need extra help. As a general rule, you should find that you
are having more good days than difficult days as your health
improves. Please talk to your nurse if this is not the case.
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Going home
When will I be ready to go home?
Having an LVAD fitted is a big operation and it can take from
two to six weeks before you are ready to go home. Some
patients can take longer than six weeks to recover, particularly
if they have been sick for a long time before surgery or if
there have been complications. You and your family or carer
will be given specific training in the care and use of your
LVAD.
What happens before I leave hospital?
One of our VAD nurses will visit your local hospital, GP surgery
and ambulance service to explain to staff that you have an
LVAD and how it works. This will allow your local healthcare
staff to be fully prepared to help should you have any
problems with the device.
When you leave hospital, we will give you medication that will
last for two weeks. Your GP can give you more medication so
please make an appointment with him or her well before your
medication runs out.
We will train a family member or carer to regularly clean the
area where the driveline leaves your body. If the area remains
free of infection, it may be cleaned as little as once a week.
We will give you a two week supply of dressings and your GP
can give you more. If your GP cannot replace some of these
items, you can contact the VAD team to request more. We will
discuss all of this with you before you go home.
It is important to realise that you must keep your LVAD
running at all times and this means you must carry spare
equipment wherever you go.
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This includes the following:
• a spare controller
• spare batteries that are fully charged
• a mobile phone to call for help if needed
• a letter explaining your specific device, why and when it was
fitted as well as the contact details for the VAD team at
Harefield to give to ambulance crews or other healthcare
professionals.
How will I feel when I get ready to go back home?
Most patients feel happy about going home but may also have
a few concerns.
In order to increase your confidence about going home, we
will gradually get you ready to leave hospital. This is called a
progressive discharge. Trips outside the hospital with your
family member or carer will help you to get ready to go home.
Some patients are concerned about feeling embarrassed in
public with the LVAD fitted. These trips will help you to get
used to any questions people may ask and help you realise
that most people do not even notice the LVAD.
If you are very concerned about going home, please tell us. We
can arrange for you to see a health psychologist who will help
you to address your concerns.
How will I keep in contact with the hospital when I am back
at home?
We will ask you to come back to Harefield Hospital for regular
follow-up appointments as an outpatient to see how you are
doing. Your first appointment is usually two weeks after you
have left hospital and we will book this before you leave.
Please call us each week to let us know how you are doing,
unless you have an outpatient appointment that week.
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You will need to have regular blood tests to check that the
level of blood thinning (anticoagulant) medicine is correct.
Your GP normally organises this once you have left hospital.
What happens if I need further help or advice when I am at
home?
Some patients may need extra support when they are back at
home. This could be help with practical issues around care or
advice on financial matters.
If you need extra support, we can put you in touch with social
workers and/or welfare rights advisers.
Are there any symptoms I should watch out for when I am at
home?
It is important that you check your temperature each day. If it
goes above 37.5 degrees, you should contact your GP and let
the VAD team know immediately. You may have an infection
and this is usually treated with antibiotics. Your GP may take a
swab, a urine sample and/or a blood sample to confirm
whether or not you have an infection.
You should also weigh yourself each day and let us know if
you lose or gain weight quickly. Weight gain over a short
period of time can be a symptom of fluid retention or heart
failure and needs to be investigated. Weight loss over a short
period of time can be a sign of dehydration.
How do I care for my LVAD at home?
It is important to follow the advice we have given you.
Remember to keep the equipment clean and take care not to
damage it. If it does become damaged, please contact the VAD
team immediately. If you accidentally drop any batteries,
please do not use them until we have checked that they are
still working properly.
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What medication will I use when I am back at home?
You will be on a variety of medication when you are back at
home. Medication may be slightly different for each patient.
You will definitely be on aspirin and warfarin tablets once a
day to help thin your blood. You will need to have your blood
tested regularly to make sure that you are still on the right
warfarin dose. We will also show you how to inject yourself
with a fast acting blood thinner should your warfarin levels be
too low.
You may also be on heart failure medication and water tablets.
Nurses and pharmacists will explain these to you before you
leave the hospital.
Wound care
After your VAD has been fitted, you will have a permanent
wound where the driveline exits your abdomen. The wound
will need further dressing and ongoing care. We will train a
family member, carer or nurse on how to care for your
driveline.
In order to prevent infection, you should not take a shower
until the skin around your driveline has completely grown
onto the driveline. The VAD team will check your driveline
when you come in to the outpatient follow-up clinic and issue
you with a shower kit once this has happened.
Trauma to the driveline exit site can lead to an increased risk
of infection. In order to minimise trauma, be careful with the
driveline and ensure it is immobilised (fixed in place) at all
times. Try not to pull, twist or bend the driveline. Take care not
to drop the controller or place unnecessary strain on the
controller’s electrical leads.
25
Please contact the VAD team immediately if:
• you have a temperature of 37.5 or above
• you experience increased tenderness or pain around the
driveline
• your wound feels hot or looks red and inflamed
• a new swelling or bruising appears
• the wound begins to ooze or there is an increase in oozing
since the previous dressing change
• the wound starts to smell
It can sometimes be difficult to get some of the items needed
to take care of the driveline. The VAD team can provide
essential items if your GP is unable to get them. To order
supplies, please contact the VAD team on 01895 823 737 or
email [email protected] at least four working days
before your outpatient clinic appointment.
Each time your driveline dressing is being changed at home,
we ask that your carer takes a digital photo and emails it to us.
This creates an electronic record of the condition of your
driveline exit site and helps us pick up potential problems
early.
If you have any concerns regarding the wound, please contact
the VAD team.
What if I have problems when I am at home?
If you have problems or worries once you are back at home,
please call Harefield Hospital on 01895 823737 and ask for the
VAD team. Non urgent enquiries can be emailed to
[email protected]
26
What should I do in the event of an emergency?
You should go to your nearest A&E or dial 999. If possible, also
contact Harefield Hospital switchboard on 01895 823 737 and
ask for the transplant registrar. If it is a problem with the
LVAD, ask for a member of the VAD team.
Lifestyle
Can I take a bath or shower?
It is important that you protect the external parts of your
LVAD from water. It will not be possible for you to take a bath.
You will be able to take a shower once your driveline has fully
healed. We will check this when you are ready to go home and
in the follow-up clinics as an outpatient. You should change
your driveline dressing after each shower as this helps
minimise the risk of infection. We ask patients not to have
more than two showers a week.
Can I have sex?
Many patients have been able to resume sexual relations after
having an LVAD fitted. If you are a female patient, please
remember that you should not get pregnant because of your
medical condition and the drug therapy that you are receiving.
Will having an LVAD interrupt my periods?
Sometimes women find that their periods stop immediately
after the procedure. This can happen after any major illness or
major surgery. In these cases, periods may not restart for many
months. If your periods have stopped, please discuss this with
your doctor or your nurse. Not having any periods after
surgery does not guarantee that you cannot get pregnant (see
section on sex above). Once your periods have restarted, they
may be heavier than before because of the anticoagulant
medicines (warfarin) that you are taking.
27
Can I drive?
You may be allowed to drive after your surgery. This depends
on:
• how well you are
• how dependent your heart and circulation are on the LVAD
• any other medical conditions that you may have
It is important that you contact the DVLA and your insurance
company and explain your situation to them. The DVLA may
request a medical report about your case from the hospital.
If you are unable to drive and find it difficult getting to your
clinic appointments, please let us know.
Can I exercise?
Most patients find they can exercise well with an LVAD even if
they were very unwell before the operation. We advise LVAD
patients to do some moderate exercise and build up slowly
over a long period. The physiotherapist will give you an
appropriate exercise programme to continue with once you
are back at home.
It is important that you do not swim or take part in contact
sports. You should avoid jumping, exercises that cause impact
on your torso and abdominal exercises such as sit-ups.
You should also avoid activities that are repetitive or cause you
to reach over such as decorating or gardening. It is very
important that you protect your driveline and LVAD
equipment during physical activity. You should always discuss
any new form of physical activity with your LVAD nurse before
you start. Please ask if you would like your physiotherapist to
give you more advice on specific types of exercise.
28
Can I go on holiday?
Once you are back home and feeling comfortable with the
device, you may want to visit friends and family or spend some
time away. We do not recommend that you travel abroad, but
you can take holidays in the UK whenever you feel ready.
Please let us know if you are planning to spend some time
away from home. The VAD team can let the local Accident and
Emergency departments and ambulance service know. This will
allow them to be better prepared in the event of an
emergency.
Are there any devices that could interfere with my LVAD?
Strong magnetic fields (such as those used for MRI scans) and
static electricity can affect your LVAD. You should avoid
touching television screens or computer monitors as these can
give off static electricity. Mobile phones do not affect LVADs.
You should keep a charged mobile on you at all times when
you are not in a hospital building.
What lifestyle changes can I make to improve my health?
If you are a smoker, stop smoking. Try to avoid smoky
environments. If you or your friends or relatives need help to
quit, call the NHS Smoking Helpline on 0800 022 4332 or visit
the website at www.gosmokefree.nhs.uk.
Drinking too much alcohol can interfere with your
blood-thinning medication. It can also cause your heart to
work less well. Alcohol impairs your judgement and reactions
and reduces your ability to deal with a problem relating to
your LVAD.
29
Remember to eat a healthy, balanced diet and to stick to the
right weight for your height. Being overweight is one factor
that may reduce your chance of receiving a transplant in the
future. Our dietitians can give you advice on this if you need
it.
Take your prescribed medication regularly. Do not use any
other medication (including over-the-counter medication)
without checking with your doctor or the VAD team first.
Remember to attend your check-up appointments regularly.
If you cannot attend for any reason, contact the VAD team.
Who can I contact for further information?
If you have any questions, please contact us through the main
switchboard on 01895 823 737 and ask for the VAD team.
If you have a medical problem, please ask for the transplant
registrar or the on call transplant SHO.
In the event of an emergency, you should go to your nearest
A&E or dial 999.
Outcome of LVAD surgery
The information on the opposite page represents our
experiences with LVAD survival at Harefield Hospital.
Table 1 shows the survival percentages from Harefield Hospital
after having an LVAD fitted in comparison to all UK centres
combined. Diagram 1 shows our recent experience at Harefield
Hospital from 1 April 2005 to 31 March 2010. Please speak to
your VAD nurse if you have any questions.
30
Survival percentages after implant of a long term LVAD
(May 2002 to March 2010)
Centre
Number
of
patients
30
days
3
months
1
year
2
years
3
years
Harefield
110
85%
78%
65%
54%
51%
All UK
Centres
228
85%
74%
63%
55%
53%
Table 1
Harefield LVAD outcome data
1 April 2005 to 31 March 2010
Implanted Patients 80
Deceased
Patients 20
Transplanted
Patients 15
Explanted (Heart
recovered) Patients 20
Ongoing
Patients 25
Diagram 1
31
© Royal Brompton & Harefield NHS FoundationTrust
Royal Brompton Hospital
Sydney Street
London
SW3 6NP
tel: 020 7352 8121
textphone: (18001) 020 7352 8121
Harefield Hospital
Hill End Road
Harefield
Middlesex
UB9 6JH
tel: 01895 823737
textphone: (18001) 01895 823 737
website: www.rbht.nhs.uk
February 2011
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