Ventricular Assist Devices

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

© 2017 American Heart Association, Inc.

• 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.

AHA Consensus on Cardiopulmonary Resuscitation in Adults and Children With Mechanical Circulatory Support

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!