Download Top Ten things you need to know*

Top Ten things you need to
know…
About VAD’s
Kim Byrum Chappell
Mechanical Assist Coordinator
#1: VAD stands for:
• Ventricular
• Assist
• Device
#2: Why are they used?
• End stage Heart Failure
• BTT (Bridge to Transplant) – Vanderbilt
– Under the watchful eye of the Transplant
Coordinators
• DT (Destination Therapy) – St. Thomas. These
patients will live with this device until death.
They are not transplant candidates.
#3: Types of VAD’s
• Pulsatile
• Continuous Flow
– Axial Flow
– Centrifugal Flow
#4: VAD’s in the Nashville Community
• Currently 8 patients are followed by Vanderbilt
• St Thomas also implants VAD’s and those patients
could show up at our doorstep
• The current VAD you would encounter in the
ER is CONTINUOUS FLOW VAD called the
Heart Mate II (HMII) made by Thoratec, Inc.
(Axial Flow)
#5: Continuous Flow = No Pulsatility
• Will most likely not be able to palpate
peripheral pulses
• Most likely unable to obtain SBP/DBP
• Most reliable/accurate measurement is by
Doppler
• Document under Manual MAP
#6: Medications
• VAD patients will be on anticoagulants –
• Coumadin
• Aspirin
• Rare – Persantine, Plavix,
• More rare/rumor – Dabigatran: there has been
discussion around this Afib approved drug but it has
not been used here…..no antidote.
#7: Components
• Pump – inside the patient (sounds like
humming)
• Driveline – white tube; exits somewhere in the
abdominal area
• System Controller – the brains
• Battery or Power Base Unit – the power
#8: Patients know their “stuff”
• Will bring a back up system controller &
batteries in case of a failure; typically in a
black bag. Must remain with patient at all
times, for all tests/procedures, transport, etc.
• Do not unplug cables to silence any alarm.
• Do not unplug both power cables at the same
time.
#9. Resources
• VAD pager #835-9109
• Thoratec supplied items:
– Clinical Operations and Patient Management book
– HMII Information and Emergency Assistance
Guide pamphlet
– HMII LVAD Pocket Guide to alarms for Clinicians
– Outpatient Emergency Response Program CD
– Thoratec eUniversity @ Thoratec.com
#10: Remember…..
• If they are speaking to you, if they are warm,
pink & with brisk capillary refill they are
perfusing.
• It’s a patient with a pump, not a pump with a
patient – so treat the patient.
• Can auscultate the pump
• Floors trained in VAD patients: 5N & 7N
• You can’t always tell a VAD patient at first
glance