Download Clinical Assessment of Pulsatile and Non

Clinical Assessment of Pulsatile
and Non-Pulsaltile VADs
Diana Joseph RN, BSN, CCTC
VAD/Heart Transplant Coordinator
OSF St. Francis Medical Center
Peoria, IL
Pulsatile Flow
Contraction or beating of the heart as felt
through the walls of the arteries
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Normal patients: Pulse is accurate
VAD patients: Not truly feeling pts
heartbeat. Asynchronous to electrical
rhythm
Types of VADs
Pulsatile VADs
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Thoratec PVAD
Thoratec IVAD
HeartMate XVE
Non-Pulsatile
VADs
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HeatMate II
HeartWare HVAD
Pulsatile VADs
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Fixed or Auto mode
Preload sensitive/Volume dependent
Radial pulse felt is the actual VAD
pumping rate
VAD rate/flows increase with activity,
volume, sepsis
VAD rate/flows decrease with rest,
hypovolemia, arrhythmias, RHF
Blood Pressure
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Ideal BP <120/
If pt is hypotensive then
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? Volume depleted
Bleeding
Arrhythmias
? RHF if LVAD
Arrhythmias
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EKG-The only true way to identify pt’s true
electrical rhythm
VAD rate/pulse is asynchronous to pt’s
electrical activity
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Atrial Fibrillation
Ventricular Tachycardia
Ventricular Fibrillation
Majority of pts will have AICD/Defibrillators
Cardioversion/Defibrillation
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Most VAD pts will tolerate arrhythmias
Assess pt if hemodynamically stable
Okay to cardiovert/defibrillate
No CPR: Could possibly damage or
dislodge cannulas/tubings resulting in
fatal internal bleeding
Hand Pump
Non-Pulsatile VADs
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Axial/Continuous Flow
RPMs
Difficult to obtain a pulse or BP
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Use a doppler for BP (narrow pulse pressure)
Ideal MAP >70
Most pts will have some residual
rhythmic contraction thus create a pulse
Arrhythmias
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EKG – Identify electrical rhythm
Okay to cardiovert/defibrillate
If RPMs too high could have
“suction events”
No Hand Pump
Caution with CPR
Basic Clinical Assessment
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Neuro-Mental Status
Peripheral Circulation-warmth
Skin color
Respiratory status
Labs if available
? VAD alarms
Assess VAD Function
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VAD alarms
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VAD readings/parameters
QUESTIONS ???