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Top Ten things you need to know…

Top Ten things you need to know…. About VAD’s Kim Byrum Chappell Mechanical Assist Coordinator. #1: VAD stands for:. V entricular A ssist D evice. #2: Why are they used?. End stage Heart Failure BTT (Bridge to Transplant) – Vanderbilt

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Top Ten things you need to know…

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  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

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