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 Driveline (tube connecting pump to outside components ) with sterile dressing covering it Republished with permission of Thoratec Corporation Pump implanted inside the chest One of two batteries needed to power the pump Controller- computer runs device; lights alarms Console used to obtain power from AC outlet

HeartMate II VAD Readings 3 Readings: Flow= cardiac output from the pump – Target varies by patient Speed= how fast pump is running rpm - range 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 mmHg

HeartMate II Care Overview EKG conduction- – 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

Test System button Battery Fuel Gauge Battery Alarm light (yellow and red) Power Symbol (green light lit when pump running) Red Heart Symbol lit: ? Pump running or not. Check PMI for mechanical hum. Controller Cell Symbol (yellow) Silence Alarm Button HeartMate II Controller Face

HeartMate II Newer Controller Face Plate

EMERGENCY CARE Call implant hospital: 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 (Paging Operator) Heart Failure Attending Ventricular Assist Device Coordinator (non- emergency)