Implantable Ventricular Assist Devices

Table of Contents

Aliases

Ventricular assist device (VAD), left ventricular assist device (LVAD), right ventricular assist device (RVAD), biventricular assist device (BiVAD)

Patient Care Goals

  1. Rapid identification of, and interventions for, cardiovascular compromise in patients with VADs
  2. Rapid identification of, and interventions for VAD-related malfunctions or complications

Patient Presentation

Inclusion Criteria

  1. Adult patients that have had an implantable ventricular assist device (VAD), including a left ventricular assist device (LVAD), right ventricular assist device (RVAD), or biventricular-assist device (BiVAD), and have symptoms of cardiovascular compromise
  2. Patients with VADs that are in cardiac arrest
  3. Patients with VADs that are experiencing a medical or injury-related event not involving the cardiovascular system or VAD malfunction

Exclusion Criteria

Adult patients who do not have a VAD in place

Patient Management

Assessment

  1. SLCH VAD Coordinator – 314-267-2064
  2. BJH VAD Coordinator – 314-454-7687
    1. option 4 (Daytime)
    2. option 2 (Night Time)
  3. Assess for possible pump malfunction
    1. Assess for alarms
    2. Auscultate for pump sound “hum”
    3. Signs of hypoperfusion including pallor, diaphoresis, altered mental status
  4. If the VAD pump has malfunctioned:
    1. Utilize available resources to troubleshoot potential VAD malfunctions and to determine appropriate corrective actions to restore normal VAD function:
      1. Contact the patient’s VAD-trained companion, if available
      2. Contact the patient’s VAD coordinator, using the phone number on the device
      3. Check all the connections to system controller
      4. Change VAD batteries, and/or change system controller if indicated
      5. Have patient stop all activity and assess for patient tolerance
      6. Follow appropriate cardiovascular condition-specific protocol(s) as indicated

Treatment and Interventions

  1. Manage airway as indicated
  2. Cardiac monitoring
  3. IV access
  4. Acquire 12-lead EKG
  5. Contact VAD coordinator if phone number is available
  6. If patient is experiencing VAD-related complications or cardiovascular problems, expedite transport to the medical facility where VAD was placed if patient’s clinical condition and time allows
  7. If patient has a functioning VAD and is experiencing a non-cardiovascular-related problem, transport to a facility that is appropriate for the patient’s main presenting problem without manipulating the device
  8. If patient has a functioning VAD and is hypoperfusing:
    1. Administer IV fluids (20 mL/kg isotonic fluid; maximum of 1 liter) over less than 15 minutes. May repeat up to 3 times based on patient’s condition and clinical impression for a total cumulative dose not exceed 3 L
      1. Best Method: Push-pull method of drawing up the fluid in a 60 cc syringe and pushing it through the IV
      2. Better Method: Commercial pressure-bag
      3. Minimum Method: Hand squeezing or blood pressure cuff
  9. If patient is in full cardiac arrest:
    1. CPR should not be performed if there is any evidence the pump is still functioning, the decision whether to perform CPR should be made based upon best clinical judgment in consultation with the patient’s VAD-trained companion and the VAD coordinator (or direct medical oversight if VAD coordinator unavailable)
    2. CPR may be initiated only where:
      1. You have confirmed the pump has stopped and troubleshooting efforts to restart it have failed, and:
      2. The patient is unresponsive and has no detectable signs of life

Notes – Implantable Ventricular Assist Devices