Long-Term Ventricular Assist Devices

Question 1

Ventricular Assist Device (VAD)

Answer 1

• Designed to support or replace a failing natural heart w/ flow assistance
  > RVAD: right ventricle
  > BiVAD: both ventricles
  > LVAD: left ventricle
• Used in pts who have advanced heart failure, as a bridge to transplant, destination therapy, bridge to recovery

Question 2

Ventricular Assist Device (VAD) - Patient Population

Answer 2

• Full recovery is not expected; using this option to wait for transplant
• Also used for pts tht cannot receive a transplant
  > improves quality of life

Question 3

Ventricular Assist Device (VAD) - Nursing Management

Answer 3

• Monitor for hemodynamic changes r/t device
• Anticoagulation therapy
  > follow protocol
• Assess for complications r/t device
• Emergency care

Question 4

Ventricular Assist Device (VAD) - Nursing Management: Monitor for Hemodynamic Changes r/t Device

Answer 4

• Preload
• Afterload
  > measured w/ systemic vascular resistance
• Maintain mean arterial blood pressure < 100
  > no palpable pulse
  > doppler mean BP; no systolic or diastolic

Question 5

Ventricular Assist Device (VAD) - Nursing Management: Assess for Complications r/t Device

Answer 5

• Bleeding
  > from VAD, GI bleed
• Infection
  > treated like a central line; sterile technique
• Thromboembolism, stroke
  > admin anticoags & antiplatelets
• Respiratory failure
  > if cardiac isn’t under control, resp will follow
• Arrhythmias
  > most will already have pacemaker
• Device failure
  > obstruction, kinked

Question 6

Ventricular Assist Device (VAD) - Nursing Management: Emergency Care

Answer 6

• Cardioversion & defibrillation should be performed for the same indications as other pts
• Do NOT do chest compressions: compressions risk cannula dislodgement, which may result in life-threatening hemorrhage