Heart Ware
What button on the HW controller needs to be held for 2 seconds to see speed, flow, power, peak, and trough?
Scroll button needs to be held for 2 seconds to scroll through speed, flow, peak, and trough on HW controller
Where does the HM2 and HM3 store data?
HM2- data stored in controller (need to program settings into back up controller)
HM3- data stored in pump (back up controller will automatically use settings stored in pump)
How often are LVAD patient weights documented?
Daily weights- standing
If patient is unable to stand d/t clinical instability- obtain bed weight and write in why bed weight was obtained
If patient refuses to stand- provide patient education, obtain bed weight if possible, and write in that patient refused weight
How is blood pressure obtained on LVAD patients? What is a normal MAP for an LVAD patient?
Doppler BP- need doppler, gel, manual BP machine, properly fitted BP cuff (can use radial or brachial site)
Normal MAP- 65-90 mmHG
Who is responsible for LVAD education? Where is education documented?
Education is performed by nurses and LVAD coordinators including dressing changes, daily management, alarm management, who to call, ect; in addition to LVAD trained techs/PT/OT providing teaching on battery/wall power changes and daily management
Education is documented q shift under the added LVAD education title (HW, HM2/3 specific). Check off what education was provided and write a short note (example= Patient verbalized understanding of alarm management and changed from battery power to wall power independently”)
Staff receive education through annual hands on skills days, My Learnings, and continuing education
What is the order that is used to change a HW controller?
Power, Patient, Pacifier, Power
Pacifier used to silence internal NO POWER ALARM when controller is not in use- should never be used on a controller with a patient driveline attached
What is the self-test used for and how is it performed?
Daily controller check uses audio and visual alarm indicators. “Self Test” appears on screen, icons illuminate, and alarm sounds.
Press and hold battery button for 5 seconds
What are the documented Heart Ware parameters?
Speed, Flow, Power, Peak, Trough
Lavare cycle on/off (provides cyclic LV and pump washout by increasing and decreasing speed)- usually off
Serial number, Mode, Hematocrit, Alarms, Safety Check
What is speed? Can you have an increase or decrease in speed?
Speed is set by provider based off patient’s clinical status (BP, symptoms, echo findings)
Higher speeds- more blood pulled from LV
Lower speeds- less blood pulled from LV
What is the JHH LVAD policy Called?
Type in “MCS” in HPO
Policy called Management of the Adult Patient Requiring Mechanical Circulatory Support (MCS), policy PAT080
What alarms cannot be silenced?
High priority alarms- flashing red (CANNOT be silenced)
Battery depleted, VAD stopped
Medium priority alarms- flashing yellow
Controller fault, high watts, low flow, suction event
Low priority alarms- solid yellow
Low Battery
Can hazard alarms be silenced?
Hazard alarm- red, can be silenced for 2 minutes
Low flow, driveline disconnect, pump off, driveline disconnect, hardware fault, no external power
Advisory alarm- yellow, can be silenced for 4 hours
Power cable disconnects, low battery, communication fault, controller fault
What are the documented Heart Mate parameters?
Speed, Flow, Power, PI
Serial number, Mode (HM2 fixed, HM3 pulse), Hematocrit (not in HM2), Alarms, Safety Check
What is flow? What causes an increase or decrease in flow?
Flow is how much blood is going through pump (calculated number) measured in L/min
Flow is calculated using speed and power
Decrease in flow- less blood through pump
Hypovolemia (over diuresis), thrombosis causing partial or full obstruction, arrhythmia, PE, tamponade, HTN, RHF
When are LVAD dressings changed? Both gauze and transparent?
Transparent- POD 0, POD 2, POD 7, q 7 days
Gauze- POD 0, POD 2, q 2 days
Always PRN, document why it is being changed outside of normal routine (changed early d/t non-occlusive, soiled, ect)
How is it document that the HW pump is a centrifugal, continuous pump?
Under “mode” it is documented as FIXED
The pump uses magnetic/hydrodynamic suspension to supply the continuous flow of blood through the pump
How is it documented that the HM3 provides an artificial “pulse”
Under “mode” it is documented as “OTHER” and typed in as “PULSE”
HM3s are referred to as pulsatile
HM2 has an axial flow device and does not provide an artificial pulse
What is the difference in parameters that the RN should alert the provider?
+/- 2 in flow, power, PI/peak+trough
Hematocrit should be changed in pump if +/- 2 (fyi provider that you changed hematocrit setting)
What is power? What causes an increase or decrease in power?
Power is the energy needed to run the pump at the programmed speed) measured in watts
Increase in power - anything that increases resistance in the pump
Decrease in power - Pump thrombosis, increase volume (hypervolemia), vasodilation, sepsis, increase physical activity
When is it decided if a patient is destination therapy or bridge to transplant? Where can this information be found in the chart?
DT or BTT is decided before LVAD placement and can be found documented in the Committee Note
HM3 is the only device that is currently approved for new implants
HM2 and HW will come in as re-admits
How long do HW batteries last? Do the batteries drain separately or together?
Last 4-6 hours
Take 4-5 hours to fully charge
Batteries drain separately (battery #1 drains to 25%, then battery #2 drains to 25%, then batteries need to be changed)
How long do HM batteries last? Do the batteries drain separately or together?
HM2: 10-12 hours
HM3: 17 hours
Takes 4 hours to fully charge
The batteries drain together
Which parameters are ACTUAL numbers and which parameters are CALCULATED numbers?
ACTUAL- speed (set by providers), hematocrit (changed by RN for changes of +/- 2)
CALCULATED- flow, power, PI/peak+trough
What is PI? What causes a PI event?
PI is a measure of the amount of pulsatility seen by the pump over a one second interval. It is based on the pressure inside the pump and is inversely related to speed. Can be used as an indicator of fluid volume status and native heart function
PI Event: 45% change from previous average – suction event (inflow cannula is obstructed), dehydration, bleeding, over diuresis, arrhythmia, vasovagal response, R heart failure
Low PI=decreased pulsatility, AKA dry
LV Empty=less stretch=little contractility= Decreased PI
Higher PI= increased pulsatility AKA fluid overload
LV Full= greater stretch= greater contractility= Increased PI
What units are trained to care for LVAD patients? Must name all!
CVPCU, CVSICU, PCCU, CCU