Top Ten things you need to know…

About VAD’sKim Byrum Chappell

Mechanical Assist Coordinator

#1: VAD stands for:

• Ventricular• Assist • Device

#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.

#3: Types of VAD’s

• Pulsatile• Continuous Flow–Axial Flow–Centrifugal Flow

#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)

#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

#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.

#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

#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.

#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

#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