1. Introduction Problem Statement 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. Some Facts Results 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. 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. 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. 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. Reflections & Implications 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). Clinical project: GI Bleeds in LVAD patients Angelica Smith, BSN, RN AGACNP Student, Class of 2015 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 Intervention