Transcript Caring for Mechanical Circulatory Device Patients

Community Preparation for
Caring for Mechanical Circulatory
Device Patients
University of Wisconsin Hospital
And Clinics
Ventricular Assist Device Program
Mechanical Circulatory Support
Device Overview
• MCDSs are devices to support the failing heart
(one side or both)
• Most MCDS patients are anticoagulated with
Coumadin and Aspirin
• All MCDSs have:
– Pump (implanted inside the patient’s chest)
– Computer to control the settings/ display VAD
performance readings
– Power source: batteries or console connected to AC
power
HeartMate II Components
Pump implanted inside the chest
One of two batteries needed to
power the pump
Driveline (tube connecting pump
to outside components) with
sterile dressing covering it
Console used to obtain power
from AC outlet
Controller- computer runs device;
lights alarms
Republished with permission of Thoratec Corporation
HeartMate II VAD Readings
3 Readings:
Flow= cardiac output from the pump
–
Target varies by patient
Speed= how fast pump is running rpm
range 8000-10000 rpm
Power= how much watts it takes to run the pump
- normal is < 8 watts
HeartMate II Care Overview
• Cannot palpate a pulse
• Pulse oximeter may/ may not work
• Need to assess if pump is running: listen over
the point of maximal impulse (PMI) area for a
consistent mechanical hum
• Blood pressure: need a Doppler and
sphygmomanometer
– result is considered a MAP
– acceptable MAP 60-85 mmHg
HeartMate II Care Overview
• EKG conduction-looks normal
– does not impact VAD function unless RV fails
– VAD will continue to receive blood supply until RV
fails or pulmonary hypertension
– Most of these patients have an ICD/ pacer. Some patients’
ICDs are off to avoid inappropriate shocks.
– Most VAD patients tolerate the arrhythmias well and may
have little symptoms for period of time.
• Assess for patient’s tolerance of situation (if able).
Ask for symptoms: lightheadedness, shortness of
breath, palpitations, bloating, pain (anywhere),
fever, chills, diaphoresis
HeartMate II Controller Face (older
version)
Battery Alarm
light (yellow
and red)
Battery
Fuel
Gauge
Silence
Alarm
Button
Test System
button
Power Symbol
(green light lit
when pump
running)
Controller
Cell
Symbol
(yellow)
Red Heart Symbol lit: ? Pump
running or not. Check PMI
for mechanical hum.
HeartMate II Newer Controller Face
Plate
EMERGENCY CARE
• Call implant hospital: 608-263-6400 and ask for HEART
FAILURE ATTENDING ON CALL
• Still need to follow Airway Breathing of ABC’s
• √ VAD stopped (listen over PMI area for consistent
mechanical hum). If stopped significant risk for clot
inside MCDS and thromboembolize.
• NO CHEST COMPRESSIONS
• Defibrillation- STANDARD METHOD
• Heparin bolus if VAD stopped (contact implant hospital
first)
Contacts
608-263-6400 (Paging Operator)
• Heart Failure Attending
• Ventricular Assist Device Coordinator (nonemergency)