Ventricular Assist Devices

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Section 4 - CARDIAC

4.14 VENTRICULAR ASSIST DEVICES

This Parameter applies to the management of patients who have a ventricular assist device (VAD) also referred to a left ventricular assist device (LVAD) implanted. The VAD is a mechanical pump used to support the heart’s pumping function and positive blood flow on individuals who have severe heart failure.

INITIATE MEDICAL CARE (2.01)

  • Perform initial assessment: vital signs, oxygen saturation, pre-treatment 12-Lead ECG, focused history (SAMPLE, OPQRST), and physical exam. Inquire if the patient has an old ECG.
    • Provide OXYGEN @ 100% via NRB mask or assist ventilations/oxygenation as indicated.
  • Listen to heart sounds. The heart sounds may be faint.
  • Check for a functioning VAD: These devices are usually implanted below the heart in the abdominal cavity area. Use a stethoscope to listen for constant humming or whirling sound. This sound confirms the VAD is functioning.
    • The nature of the VAD function provides positive constant flow (it is a centrifugal pump) therefore a pulse may not be palpable in these patients.
  • Blood Pressure: A manual blood pressure may not be obtainable. An automated blood pressure monitoring device may provide a reading with a narrow pulse pressure.
    • Treatment of these patients must be based on the mean arterial pressure (MAP). The normal MAP should be between 60 and 90 mm/Hg.
  • Pulse Oximetry: These readings may not be accurate due to the continuous flow provided by the VAD.
    • Monitor side capnography for ventilation and oxygenation effectiveness.


UNRESPONSIVE PATIENT

  • If the patient is unresponsive to stimuli:
    • Open the airway and ventilate/oxygenate as necessary.
    • Obtain a blood glucose level and treat per 5.10 Hypoglycemia parameter as needed.
  • Listen for a functioning VAD by auscultating over the abdomen.
    • If the VAD has a whirling sound it is properly functioning.
    • DO NOT PERFORM CPR!
      • A VAD or LVAD is surgically implanted to the left ventricle. External cardiac compressions may dislodge the VAD causing death.
  • If the VAD is silent have the caregiver or family member check the device external pump controller and power supply.
    • LISTEN TO THE CAREGIVER! These individuals are experts in these devices and know/understand how to operate and troubleshoot the system.
    • VAD patients are instructed to always have a backup bag with 2 charged batteries and a second pump controller.
    • Contact the LVAD coordinator on call (based at Florida South).
  • If the VAD is inoperative despite troubleshooting and battery replacement, then CPR is indicated as per cardiac arrest parameter.


RESPONSIVE PATIENT:

  • Perform a subjective interview to determine chief complaint and history of present illness.
  • Monitor ECG and obtain a 12 lead ECG if chest pain, ischemic symptoms, shortness of breath or weakness is reported.
    • Any cardiac dysrhythmias must be treated per the appropriate practice parameter.
    • If electrical therapy is indicated on a conscious patient, the patient may be sedated (time permitting) as per parameter 2.04 Analgesia/Sedation.
  • Establish IV access and provide fluid resuscitation as indicated based on patient’s condition and hydration status.
  • Assess for any other concurrent medical conditions or symptoms and treat per the appropriate parameter.


TRANSPORT OF PATIENT:

  • ALL VAD patients with cardiac, respiratory, neurological or infectious disease complaints must be transported to the VAD center.
    • Currently Florida Hospital Orlando is the only local approved VAD center.
    • Contact the VAD coordinator as soon as possible and notify them of the transport.
  • VAD patients presenting with minor complaints may be transported to any receiving facility as long as they have their backup batteries and equipment with the patient.
    • These complaints include, but are not limited to:
      • Minor sprains, strains or orthopedic injuries
      • Hypoglycemia without severe signs or symptoms
      • Isolated extremity lacerations
  • Don’t forget the family member/caregiver!
    • The family member/caregiver must ACCOMPANY the patient in the ambulance.
    • These individuals have intimate knowledge of the patient’s condition, the system and usually have legal authority to sign on behalf of the patient.
  • Bring all VAD equipment, backup bags, charger and batteries with the patient!