1. Top Ten things you need to know… About VAD’s Kim Byrum Chappell Mechanical Assist Coordinator

2. #1: VAD stands for: Ventricular Assist Device

3. #2: Why are they used? End stage Heart Failure BTT (Bridge to Transplant) – Vanderbilt – Under the watchful eye of the Transplant Coordinators DT (Destination Therapy) – St. Thomas. These patients will live with this device until death. They are not transplant candidates.

4. #3: Types of VAD’s Pulsatile Continuous Flow – Axial Flow – Centrifugal Flow

5. #4: VAD’s in the Nashville Community Currently 8 patients are followed by Vanderbilt St Thomas also implants VAD’s and those patients could show up at our doorstep The current VAD you would encounter in the ER is CONTINUOUS FLOW VAD called the Heart Mate II (HMII) made by Thoratec, Inc. (Axial Flow)

6. #5: Continuous Flow = No Pulsatility Will most likely not be able to palpate peripheral pulses Most likely unable to obtain SBP/DBP Most reliable/accurate measurement is by Doppler Document under Manual MAP

7. #6: Medications VAD patients will be on anticoagulants – Coumadin Aspirin Rare – Persantine, Plavix, More rare/rumor – Dabigatran: there has been discussion around this Afib approved drug but it has not been used here…..no antidote.

8. #7: Components Pump – inside the patient (sounds like humming) Driveline – white tube; exits somewhere in the abdominal area System Controller – the brains Battery or Power Base Unit – the power

9. #8: Patients know their “stuff” Will bring a back up system controller & batteries in case of a failure; typically in a black bag. Must remain with patient at all times, for all tests/procedures, transport, etc. Do not unplug cables to silence any alarm. Do not unplug both power cables at the same time.

10. #9. Resources VAD pager #835-9109 Thoratec supplied items: – Clinical Operations and Patient Management book – HMII Information and Emergency Assistance Guide pamphlet – HMII LVAD Pocket Guide to alarms for Clinicians – Outpatient Emergency Response Program CD – Thoratec eUniversity @ Thoratec.com

11. #10: Remember….. If they are speaking to you, if they are warm, pink & with brisk capillary refill they are perfusing. It’s a patient with a pump, not a pump with a patient – so treat the patient. Can auscultate the pump Floors trained in VAD patients: 5N & 7N You can’t always tell a VAD patient at first glance