Transcript HeartMate LVAD & Thoratec VAD VAD Resource Team University

HeartMate XVE LVAD
VAD Resource Team
University of Washington Medical Center
VAD Resource Team
Pager/Phone
Email
Cardiac Surgery
Shauna Andrus
5NE/5SE Sheryl Greco
994-6986
sandrus
994-4535
sagreco
5NE Kristina Green
598-4500
kegreen
5SE Nicola Kaye
598-6500
kiwi
5SE Janie Shively
598-7369
janie
5NE Eileen Suver
598-4500
esuver
5SE Teddy Villamarin
598-6500
pinoy
Heart Failure
•
Heart failure is defined as the inability of the heart to
effectively pump oxygenated blood to meet the metabolic
demands of the body.
•
This devastating condition affects 4.7 million people a year
in the United States alone.
•
When conventional medical therapies are unsuccessful,
cardiac transplantation is an option for treatment and to
prolong life.
•
Unfortunately, only 2300 patients each year receive heart
transplants, because the number of patients awaiting
transplants far exceeds the number of organs available.
HeartMate Candidates
• Transplant candidate:
• dependent on vasopressor support
OR
• incomplete response to continued
vasopressor support
• Approved for ‘Destination Therapy’
• BSA of 1.5 or greater
Pump
Percutaneous Tube
Vent Adapter
Weight: 3.74 lbs
Pump volume: 83 ml
Rate: Up to 120
Flow: Up to 10 L/min
Titatanium
Motor with 2 bearings
Vent port
Two tissue valves:
Inflow & Outflow
Inside surface of pump housing
Percutaneous Tube
&
Vent Adapter
AVOID:
WATER & POWDER AROUND FILTER
System Controller
“Quick” Connector
System Controller Cables
System Controller
‘Brains’ of system (computer)
Alarms: Audible & Visual
Two cables: connect to power source
‘Quick connect’ to percutaneous lead
System Controller
Change Mode
System Check
Alarm Reset
Battery Power Check
Power Base Unit (PBU)
& System Monitor
Power Base Unit
PBU
Internal
battery
Battery
charger
•AC Fail
•Low Batt
•Alarm reset
Screen of System Monitor
Pump Rate:
Rate PUMP
is beating
Flow:
Cardiac
output
Stroke
volume:
FUNCTION BUTTONS
Auto/Fixed
Fixed Rate 
Fixed Rate 
ml/beat
FIXED vs. AUTO MODE
 FIXED MODE is a set rate the pump will beat at
regardless of other conditions. This rate can be
adjusted by using the system monitor, and should
always be set at a rate close to the patient’s baseline.
 AUTO MODE is responsive to the filling and emptying
of the LVAD pump. The pump fills to a fixed volume at
a variable rate depending on the patient’s activity and
volume status.
 NO RELATIONSHIP TO RATE OR RHYTHM OF HEART
Display Module
DISPLAY
•Provides information ONLY
•No button interface
Components:Tethered
1. Quick Connect:
percutaneous tube
to system controller
2. Power Base Unit
Cable: connecting
cable from PBU to
system controller
3. Twist together
connection: system
controller to power
base unit cable
4. Twist together
connection: system
controller to power
base unit cable
Components: Battery Powered
BATTERY
•Requires 2
batteries
•4-6 hours of
power/set
•Worn in holster
1. Quick Connect
2. Twist together connect: system controller to battery
3. Twist together connect: system controller to battery
Hand Pump: Goes with patient EVERYWHERE
Emergency Power Pack
Battery Clips & Batteries
Changing Power Sources
YELLOW WRENCH: ADVISORIES
• 1 beep per second
• May be silenced for 24 hours
RED HEART: HAZARD ALARMS
• Steady tone alarm
• Preceded and accompanied by a
Yellow Wrench alarm
• May be reset for 2 minutes
YELLOW WRENCH
1. Power Cable Disconnect
MOST COMMON
Routine alarm that sounds when power
source (battery or outlet) is changed
or only one power source connected
• Check the connections to the power source
YELLOW WRENCH
2. Controller Malfunction
2nd MOST COMMON
Caused by a malfunction in the
system controller
*Inoperative Controller = ½ wrench*
• Change the system controller
YELLOW WRENCH
3. Power Limit Advisory
RARE
Occurs when pump has higher than
normal pressure to pump against
• Kinked or occluded vent line
 replace the extension
• High blood pressure to pump against
 lower blood pressure
YELLOW WRENCH
4. Rate Control Fault
RARE
Occurs when pump is changed to
Fixed Mode and the preset rate is:
Less than 50
or
Greater than 120
•
Pump defaults to 72 beats per minute
 correct by attaching the system
monitor and changing the backup
rate
YELLOW WRENCH: ADVISORIES
• 1 beep per second
• May be silenced for 24 hours
RED HEART: HAZARD ALARMS
• Steady tone alarm
• Preceded and accompanied by a
yellow wrench alarm
• May be reset for 2 minutes
RED HEART
1. Low Beat Rate or No Op
Low Beat Rate:
Pump slows to < 30 bpm
No Op: may be stopped
THIS IS A CRITICAL ALARM
AND
CANNOT BE RESET
• Check connections
most likely culprit is the percutaneous tube
connection to the system controller
• Check your patient
 you may need to hand pump
• Check the vent port to insure it is not occluded
• Try changing the power source
• Try changing the system controller
• If pumping does not resume immediately,
remove all power sources and start hand
pumping
• STAT page the perfusionist on call
• STAT page Surg C Attending or Fellow
• Call for pneumatic console (5NE) with
Stroke Volume Limiter (SVL)
• Do NOT restart the pump if it has been off
> 5 minutes except with order from
Attending or Fellow
RED HEART
2. Low Stroke Volume: < 25 ml
3. Low Flow: < 1.5 L/min
• STAT page perfusion
• STAT page Surg C Attending or Fellow
• Consider changing to Fixed Mode to  flow
• Assess whether this is a patient or equipment
problem
RED HEART CAUSES
• Severe RV failure  consider inotropes
• Extreme low blood volume  assess for
bleeding or fluid loss, replace fluids
• VT, VF or Asystole  ACLS protocols
EXCEPTION: NO chest compressions
(may dislodge outflow conduit)
• LV inflow cannula obstruction
 requires surgical intervention
FLASHING YELLOW BATTERY
RED HEART
YELLOW WRENCH
Steady tone
CANNOT BE SILENCED
XVE System Controller
disconnected from the percutaneous tube
• Check system controller cable connection
to percutaneous tube
BATTERY ALARMS
• Flashing Yellow Battery
• No tone
• Yellow Battery
• Once-per-second
• Red Battery
• Continuous Audio Tone
FLASHING YELLOW BATTERY
No tone
Battery Module
The battery that controls the alarm lights
and tones on the system controller is low
•
This battery controls ONLY the alarm tones
and lights, NOT the pump
• Change the battery, then do a controller
self-test to clear the alarm
YELLOW BATTERY
Once-per-second BEEP
Low Voltage Advisory
Less than 15 min of battery power remain
•
Change to alternate power source
RED BATTERY:
Steady tone
Low Voltage Alarm
Less than 5 minutes of battery power remains
•
Pump defaults to POWER SAVER MODE: 50 bpm
 Patient may be symptomatic @ this rate if used
to faster rate
•
Immediately switch to an alternate power source
or prepare to hand pump
EMERGENCIES
• VT/VF
Monitor BP; Flows; Cardiovert/Defibrillate
• BLOOD FROM EXIT SITE
STAT page CT surgeon &/or fellow
• RED HEART
Trouble shoot; be prepared to hand pump
STAT page CT surgeon &/or fellow
IF LVAD MOTOR STOPS
< 5 minutes
> 5 minutes
• Troubleshoot and
• DO NOT attempt to
•
•
•
get it working
again
Try hand pumping
Replace system
controller
Try pneumatic
console (with SVL)
restart motor
• STAT page
perfusionist
• STAT page Surg C
Attending/Fellow
Pneumatic Console
Can drive XVE HeartMate if
pump failure
Must use
STROKE VOLUME LIMITER
Pneumatic tubing with
flutter diaphragm
FIXED only available mode
No electric connections to
provide pump information
Consider transfer to 5SE
No alarms on IP console
Three months after implant
University of Washington Medical Center
1997-2006
Device
Total
TX
IP HeartMate
19
17
VE HeartMate
22
20
XVE HeartMate
26
23
Thoratec PVAD
24
5
Thoratec IVAD
2
1
XVE HeartMate DT/HM II DT
4
HM II
TOTAL
*4 Combo HeartMate + Thoratec
7
102*
Waiting/
Current
1
1
1
66
2