heartmate xve lvad university of washington medical center vad resource team university of...

HeartMate XVE LVAD

VAD Resource TeamUniversity of Washington Medical CenterUniversity of Washington Medical Center

VAD Resource Team

Pager/Phone

Email

Cardiac Surgery Shauna Andrus

994-6986 sandrus

5NE/5SE Sheryl Greco 994-4535 sagreco

5NE Kristina Green 598-4500 kegreen

5SE Nicola Kaye 598-6500 kiwi

5SE Janie Shively 598-7369 janie

5NE Eileen Suver 598-4500 esuver

5SE Teddy Villamarin 598-6500 pinoy

Heart Failure

• Heart failure is defined as the inability of the heart to effectively pump oxygenated blood to meet the metabolic demands of the body.

• This devastating condition affects 4.7 million people a year in the United States alone.

• When conventional medical therapies are unsuccessful, cardiac transplantation is an option for treatment and to prolong life.

• Unfortunately, only 2300 patients each year receive heart transplants, because the number of patients awaiting transplants far exceeds the number of organs available.

HeartMate Candidates

• Transplant candidate: •dependent on vasopressor support

OR •incomplete response to continued

vasopressor support

• Approved for ‘Destination Therapy’

• BSA of 1.5 or greater

Pump Percutaneous Tube

Vent Adapter

Weight: 3.74 lbs

Pump volume: 83 ml

Rate: Up to 120

Flow: Up to 10 L/min

Titatanium

Motor with 2 bearings

Vent port

Two tissue valves:

Inflow & Outflow

Inside surface of pump housing

Percutaneous Tube &

Vent Adapter

AVOID:

WATER & POWDER AROUND FILTER

System Controller

“Quick” Connector

System Controller Cables

System Controller

‘Brains’ of system (computer)

Alarms: Audible & Visual

Two cables: connect to power source

‘Quick connect’ to percutaneous lead

System Controller

Change Mode Alarm Reset

System Check Battery Power Check

Power Base Unit (PBU) & System Monitor

Power Base UnitPBU

Internal battery

Battery charger

•AC Fail•Low Batt•Alarm reset

Screen of System Monitor

Pump Rate:

Rate PUMP is beating

Flow:

Cardiac

output

Stroke

volume:

ml/beat

FUNCTION BUTTONS

Auto/Fixed Fixed Rate Fixed Rate

FIXED vs. AUTO MODE

FIXED MODE is a set rate the pump will beat at regardless of other conditions. This rate can be adjusted by using the system monitor, and should always be set at a rate close to the patient’s baseline.

AUTO MODE is responsive to the filling and emptying of the LVAD pump. The pump fills to a fixed volume at a variable rate depending on the patient’s activity and volume status.

NO RELATIONSHIP TO RATE OR RHYTHM OF HEART

Display Module

DISPLAY

•Provides information ONLY

•No button interface

Components:Tethered

1. Quick Connect: percutaneous tube to system controller

2. Power Base Unit Cable: connecting cable from PBU to system controller

3. Twist together connection: system controller to power base unit cable

4. Twist together connection: system controller to power base unit cable

Components: Battery Powered

1. Quick Connect

2. Twist together connect: system controller to battery

3. Twist together connect: system controller to battery

BATTERY

•Requires 2

batteries

•4-6 hours of

power/set

•Worn in holster

Hand Pump: Goes with patient EVERYWHERE

Emergency Power Pack

Battery Clips & Batteries

Changing Power Sources

• Steady tone alarm• Preceded and accompanied by a Yellow Wrench alarm

• May be reset for 2 minutes

RED HEART: HAZARD ALARMS

• May be silenced for 24 hours

• 1 beep per second

YELLOW WRENCH: ADVISORIES

YELLOW WRENCH

1. Power Cable DisconnectMOST COMMON

Routine alarm that sounds when power source (battery or outlet) is changedor only one power source connected

• Check the connections to the power source

YELLOW WRENCH

2. Controller Malfunction2nd MOST COMMON

Caused by a malfunction in the system controller

*Inoperative Controller = ½ wrench*

• Change the system controller

YELLOW WRENCH

3. Power Limit Advisory RARE

Occurs when pump has higher than normal pressure to pump against

• Kinked or occluded vent line Kinked or occluded vent line

replace the extensionreplace the extension• High blood pressure to pump High blood pressure to pump against against

lower blood pressurelower blood pressure

YELLOW WRENCH

4. Rate Control Fault RARE

Occurs when pump is changed to Fixed Mode and the preset rate is:

Less than 50 or

Greater than 120

• Pump defaults to 72 beats per minutePump defaults to 72 beats per minute

correct by attaching the system correct by attaching the system monitor and changing monitor and changing

the backup ratethe backup rate

• Steady tone alarm

• Preceded and accompanied by a yellow wrench alarm

• May be reset for 2 minutes

RED HEART: HAZARD ALARMS

• May be silenced for 24 hours

• 1 beep per second

YELLOW WRENCH: ADVISORIES

RED HEART1. Low Beat Rate or No Op

Low Beat Rate:Pump slows to < 30 bpm

No Op: may be stopped

THIS IS A CRITICAL ALARM AND

CANNOT BE RESET

• Check connectionsmost likely culprit is the percutaneous

tube connection to the system controller

• Check your patient you may need to hand pump

• Check the vent port to insure it is not occluded

• Try changing the power source

• Try changing the system controller

• If pumping does not resume immediately, remove all power sources and start hand pumping

• STAT page the perfusionist on call

• STAT page Surg C Attending or Fellow

• Call for pneumatic console (5NE) with Stroke Volume Limiter (SVL)

• Do NOT restart the pump if it has been off > 5 minutes except with order from Attending or Fellow

RED HEART

2. Low Stroke Volume: < 25 ml3. Low Flow: < 1.5 L/min

• STAT page perfusion

• STAT page Surg C Attending or Fellow

• Consider changing to Fixed Mode to flow

• Assess whether this is a patient or equipment problem

RED HEART CAUSES

• Severe RV failure consider inotropes

• Extreme low blood volume assess for bleeding or fluid loss, replace fluids

• VT, VF or Asystole ACLS protocols EXCEPTION: NO chest compressions (may dislodge outflow conduit)

• LV inflow cannula obstruction requires surgical intervention

XVE System Controller disconnected from the percutaneous tube

FLASHING YELLOW BATTERY RED HEART

YELLOW WRENCHSteady tone

CANNOT BE SILENCED

• Check system controller cable connection

to percutaneous tube

BATTERY ALARMS

• Flashing Yellow Battery

•No tone

• Yellow Battery

•Once-per-second

• Red Battery

•Continuous Audio Tone

FLASHING YELLOW BATTERYNo tone

Battery Module

The battery that controls the alarm lights and tones on the system

controller is low

• This battery controls ONLY the alarm tones and lights, NOT the pump

• Change the battery, then do a controller self-test to clear the alarm

Low Voltage Advisory

Less than 15 min of battery power remain

YELLOW BATTERYOnce-per-second BEEP

• Change to alternate power source

RED BATTERY:Steady tone

• Pump defaults to POWER SAVER MODE: 50 bpm Patient may be symptomatic @ this rate if

used

to faster rate

• Immediately switch to an alternate power source or prepare to hand pump

Low Voltage Alarm

Less than 5 minutes of battery power remains

EMERGENCIES

•VT/VFMonitor BP; Flows; Cardiovert/Defibrillate

•BLOOD FROM EXIT SITESTAT page CT surgeon &/or fellow

•RED HEART Trouble shoot; be prepared to hand pumpSTAT page CT surgeon &/or fellow

IF LVAD MOTOR STOPS

< 5 minutes• Troubleshoot and

get it working again

• Try hand pumping

• Replace system controller

• Try pneumatic console (with SVL)

> 5 minutes• DO NOT attempt

to restart motor

• STAT page perfusionist

• STAT page Surg

C Attending/Fellow

Pneumatic ConsoleCan drive XVE HeartMate if pump failure

Must use STROKE VOLUME LIMITER Pneumatic tubing with

flutter diaphragm

FIXED only available mode No electric connections to provide pump information

Consider transfer to 5SE No alarms on IP console

Three months after implant

University of Washington Medical Center

1997-2006Device Total TX

Waiting/Current

IP HeartMate 19 17  

VE HeartMate 22 20  

XVE HeartMate 26 23 1

Thoratec PVAD 24 5  

Thoratec IVAD 2 1

XVE HeartMate DT/HM II DT 4   1

HM II 7 1 2

TOTAL 102* 66  *4 Combo HeartMate + Thoratec