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VAD Community Training

Transplant & VAD ProgramFrederik Meijer Heart & Vascular Institute

Images "Reprinted with the permission of Abott“; Medtronic; and Clipart

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Objectives:

Discuss what a LVAD is and why it is needed

Understand differences in obtaining vitals signs and patient assessment

State how and who to call for questions or concerns

What is a LVAD?

L: Left

V: Ventricular

A: Assist

D: Device

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Why is a LVAD Needed?

■ Advanced Heart Failure■ Exceeded medical therapy■ Bridge to Transplant■ Destination Therapy

5Image: National Heart, Lung and Blood Institute

Bridge to Transplant

■ People waiting for a heart transplant

■ Must meet criteria for a transplant ■ Must be on the transplant list

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Destination Therapy

■ Improve quality of life■ Increase life expectancy■ Transplant is not an option

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VADs- 3 Types at Spectrum Health

Heartmate II Heartmate III HeartWare

LVAD: HeartMate II®

Parts:1. Pump2. Driveline3. System Controller4. Power Cables5. Batteries6. Battery Clips

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Heartmate II Pump

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Takes blood from left side of heart

PumpSend blood to rest of body

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HeartMate III Pump

Inflow Conduit(20 mm)

Rotor & Mag-Lev- Blood path with Textured Surfaces

Sealed Outflow Graft

(14 mm) w/Bend Relief

Percutaneous Cable

System Controller (Pocket)

• Small computer that controls the operation of the pump

• Powers the pump through batteries or the power module

• Alarm notification

• Battery fuel gauge indicates power left in batteries

• Back up battery

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LVAD: HeartMate II®

Parts:1. Batteries2. Battery Clips3. Battery Charger

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5, 6

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Alarms and Emergencies

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Screen will display a message stating the alarm and required action

Refer to alarm guide

Patient or Caregiver are trained in alarm response

Call 877-446-4199 for any alarms

Red Heart Symbol

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What do you do?■ Make sure system controller is connected to pump

driveline■ Make sure system controller is connected to

power■ Call 1-877-446-4199 tell them “I have a VAD Emergency and need to speak to the VAD person on-call”

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HeartWare

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HeartWare® Pump

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HeartWare® System

Small pump attaches directly to heart

Thin, flexible driveline cable exits skin

A small controller & batteries run the pump

HeartWare Wearable

HeartWare® ControllerThe controller sends power and operating signals to the HVAD® Pump via a percutaneous driveline. It also collects data on system operation.

Driveline ConnectionPump driveline is attached to silver driveline connector and

must not be disconnected

Power Connection

Power Connection2 identical power supply connectors

– controller requires two power sources at all times

Controller DisplayProvides information on pump parameters (flow,

speed, power), power sources and alarms

Data ConnectionData connector is used by clinicians

to adjust pump parameters and download pump information

Three Options:

1. One battery and AC adapter: stationary (e.g. rest, bed, etc.)

2. Two batteries: ambulatory

3. One battery and DC adapter: car

Power Sources for the HeartWare®

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Understanding AlarmsAlarms tell you about the pump, controller, connections,

or the power supply

Alarms conditions are classified as high, medium or low

When an alarm occurs, two lines of words appear in the controller display

1st line tells you what the alarm is

2nd line tells you what do to

Summary of Alarm Display and Audio by Alarm Type

High Medium Low

Controller DisplayFlashing Red Triangle Flashing Yellow Triangle Solid Yellow Triangle

ControllerAudio

• Loudest intermittent beep

• Cannot be silenced by the Mute Button

• Intermittent beep that becomes louder in 1 and 5 min

• Intermittent beep that becomes louder in 5 and 10 min

Controller Silencing

• Cannot be silenced by the Mute Button

• The alarm will clear once the problem is resolved

• May be silenced for 5 min or 1 hour

• Controller and Electrical Faults may be permanently silenced

• May be silenced for 5 min

High Priority Alarms

Alarm Type Alarm Display (line 1)

Action (line 2)

High – Critical(Blank Display) No Message No Message

High – Critical(Flashing Red)

VAD Stopped Connect Driveline

VAD Stopped Change Controller

Critical Battery 1 Replace Battery 1

Critical Battery 2 Replace Battery 2

Controller Failed Change Controller

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Assessment

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Vital Signs

Patient may not have a pulse due to the continuous flow of the pump

Blood pressure obtained using a B/P cuff and Doppler

Video: How to take a Doppler blood pressure

■ Normal MAP is 60-90

Oxygen saturation measurement may be unreliable

Perform assessment as it pertains to the chief complaint

Consider signs of heart failure27

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Back-up Equipment

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Back-up Equipment Transport patient to ED with their equipment Batteries Bag Emergency back-up bag Back-up controller 2 fully charged batteries Alarm guide

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Emergency Response

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Non-VAD Related Emergencies

Support the patient as needed

Remember these patients are anti-coagulated and have an increased risk of bleeding

Pumps are volume dependent- function will be affected by loss of preload

Caregivers are excellent resources- listen to them and ask for help, as needed

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Emergency: Who to call

Call 877-446-4199

■ “I have a VAD emergency and need to speak to the VAD contact person on call”

■ Give the patient’s name and contact number including area code. Stay on the line if possible.

■ If you haven’t been connected in 5 minutes ask for the page to be repeated

■ MD will assist with treatment decisions and/or help to troubleshoot alarms, pump malfunction

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Transport

Patient should be transported to nearest VAD facility-

Spectrum Health Butterworth ED

Transport by ground or air

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Cardiac Arrest- No Chest Compressions

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Code Blue

Follow BLS and ACLS Algorithm, but do not do compressions unless directed by Advanced Heart Failure MD

Support ventilation and treat any dysrhythmias according to AED or defibrillator

Patient can be defibrillated or cardioverted without disconnecting the VAD.

DO NOT DISCONNECT THE VAD

Is the pump running? Listen for the whirring sound over the left side of the chest.

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Questions? Concerns? Who do you call?

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616-391-2802