Community Preparation for Caring for Mechanical Circulatory

Device PatientsUniversity of Wisconsin Hospital

And ClinicsVentricular 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 Readings3 Readings:Flow= cardiac output from the pump

– Target varies by patient

Speed= how fast pump is running rpm- range 8000-10000 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 60-85 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 Systembutton

BatteryFuel 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.

ControllerCell Symbol(yellow)

SilenceAlarmButton

HeartMate II Controller Face

HeartMate II Newer Controller Face Plate

EMERGENCY CARE

• Call implant hospital: 608-263-6400 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

608-263-6400 (Paging Operator)

• Heart Failure Attending

• Ventricular Assist Device Coordinator (non-emergency)