Transcript Clinical Project Poster

Clinical project: GI Bleeds in LVAD patients
Angelica Smith, BSN, RN
AGACNP Student, Class of 2015
Post-test highlights
• 100% Correctly identified ways to prevent GI bleeds.
• 100% Correctly identify signs and symptoms of GI bleeds.
• 100% Correctly identified treatment options for GI bleeds
• 100% Correctly identified what to do if they suspected GI bleed
Evaluation
• 100% strongly agreed or agreed that they had a better understanding about
GI Bleeds in patients with LVADs.
• 100% strongly agreed or agreed that the information presented in the
brochure was helpful and informative.
GI Bleeds in patients with LVADs is significantly associated morbidity and
can threaten a patient's life as well as their ability to undergo eventual heart
transplantation secondary to both general health/strength and the
potential development of antibodies to blood products that would make
future transfusions and transplantations more difficult.
Goal and Objectives
Goal: Educate LVAD patients and their families about GI bleeds.
Objectives upon completion of presentation:
• Participants will identify at least 2 ways to prevent GI bleeds.
• Participants will identify at least 3 signs and symptoms of GI bleeds.
• Participants will identify at least 3 treatment options for GI bleeds.
• Participants will identify what to do if they suspect GI bleeds.
Intervention
The interventions included:
• Educating patients with LVADs about prevalence of GI bleeds after LVADs
implantation
• Educating patients with LVADs about risk factors for GI bleeds after LVADs
implantation
• Educating patients with LVADs about GI bleed prevention after LVADs
implantation
• Educating patients with LVADs about signs and symptoms of GI bleeds after
LVADs implantation
• Educating patients with LVADs about diagnostic techniques for GI bleeds after
LVADs implantation
• Educating patients with LVADs about treatment options of GI bleeds after LVADs
implantation
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Problem Statement
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FIGURE 1: PERCENT (%) OF SURVEYED PATIENTS WHO CORRECTLY
ANSWERED THE PRE AND POST TEST QUESTIONS
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• Nearly 50% of all patients that have LVADs suffer from GI bleeds at some point
or another after transplantation, regardless of their bleeding tendencies prior
to the insertion of the device.
• LVAD patients are at higher risk for GI bleeds that include use of aspirin,
Coumadin, Heparin.
• In LVAD patients most GI bleeds occur from the way that the LVAD works. By
the LVAD providing a constant blood flow to the intestines it makes them more
likely to leak blood by creating leaky AVMs.
• The most common treatment options are: Blood transfusion, Octeotride
injection, Iron pill supplements, Iron infusion, PPIs.
• Most patients with LVADs that develop GI bleed, develop chronic GI bleeds
without resolution other than heart transplantation.
• Upper (EGD) and lower endoscopy (colonoscopy) are the most accurate ways
to identify the GI bleed.
Results
% OF CORRECTLY ANSWERED
The clinical problem faced by patients with Left Ventricular Assistive
Device (LVAD) implants is that the device supplies blood to the
systemic circulation in a continuous flow fashion. Research findings
publicized by the Gastroenterology Research and Practice journal
(2012) has suggested that patients with LVADs have a tendency to
develop arteriovenous malformations (AVMs). AVMs are abnormal
blood vessels in the gastrointestinal (GI) tract and are a common
source of bleeding. They can develop through venous obstruction or
hypo perfusion, and may be associated with aortic stenosis or renal
insufficiency (Meyer, Young, Sun, Azzouz, & Firstenberg, 2012). It has
been suggested that no pulsatile left ventricular assist devices
(LVADs) may contribute to GI bleeds caused by AVMs due to the
lower pulse pressure generated by these devices, similar to aortic
stenosis (Meyer, Young, Sun, Azzouz, & Firstenberg, 2012).
Some Facts
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Introduction
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QUESTION NUMBER
Pre test
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Post test
Analysis
In all, the pre-and post-tests showed that before then intervention 50% of
the patients surveyed were aware of the prevalence on GI Bleeds in patients with
LVADs, that LVADs contributed to GI Bleeds, that Protonix helped reduced GI
Bleeds, and the treatment options available to them. 70% recognized the signs and
symptoms of GI bleeds and 70% recognized that colonoscopies are used to help
detect GI bleeds. Most patients were aware that GI bleeds occur with LVADs , but
were surprised that the prevalence was as high as 50%. Among the treatment
options presented, most patients (50%) did not recognized octeotride as a
treatment option for GI bleeds.
Reflections & Implications
Overall, the clinical project was a success and an effective primary health
promotion tool in educating LVAD patients and their families about GI bleeds in
patients with LVADs. In the future, it needs to be emphasized in patients that may
receive LVADs or that have LVADS about the prevalance, treatment options, signs
and symptoms, and diagnostic testing in order to help reduce morbidity related to
GI bleeds in patients with LVADs.