Equipment
When do we clean VAD equipment?
Before AND after patient use.
Can a patient travel without an RN to procedure or test when they are in the CCU?
Patients in CCU must be accompanied by a VAD Competent Nurse.
Patients on the floor only need to be accompanied by a VAD Competent Nurse if they are unable to care for their VAD, are newly implanted and cannot take care of their VAD or receive sedation.
What do patients need to be taught to bring with them when they come to the hospital?
Back up controller and extra set of batteries
Where can you find MMC Performance Measures for VAD patients?
LVAD poster on the unit
What is the name of the flowsheet for documentation?
Under the VAD flowsheet
What is approved cleaner for VAD equipment?
Sani-cloth only.
What do you do if you suspect there is a problem with any part of the LVAD?
Call heart success.
Who is responsible for anticoagulation teaching?
Name 3 disciplines.
Pharmacy
Nursing
Dietary (coumadin diet teaching)
How do you know how often to change the VAD dressing and how do you know what type of dressing kit to use?
Frequency of dressing changes will appear as an order in Epic under orders. Type of dressing kit will also be specified (Daily or Weekly dressing kit).
How often are MAPs documented?
As ordered
What must we ensure is present with patients with when travelling anywhere? This includes admission, transfer, or procedure.
Back up controller
2 Extra Batteries
2 Extra Clips (HM only)
Where are VAD Guidelines located?
There is a VAD resource binder on each VAD competent unit
What are the focuses of education for patients and families prior to discharge?
Dressing changes, VAD alarms, and ADLs
What are other quality measures that are monitored?
30 day re-admission, GIB, 30-day survival, 90-day survival, stroke within 30 days, infection within 3 months of implant, device malfunction
What are the different types of order sets?
Pre/Post Op
LVAD order set
How often are equipment carts checked by the VAD team?
Monthly
How do you find the MAP of an LVAD patient?
MAP is found using manual BP cuff and doppler
It is a systolic measurement found at either the radial or brachial pulse points with a target of 65-85
What should LVAD patients and families for taught as signs and symptoms of driveline infection?
Temperature greater than 38 degrees C, erythema or drainage at insertion site
Name all 4 quality measures for our LVAD patients.
1. 1 year readmission rate
2. Out of bed and ambulating within 72 hours of implantation
3. Driveline infection rate
4. Length of stay
What are the 3 main components of documentation on the VAD flowsheet?
VAD settings (Flow, speed, PI, power, back up controller, system checks)
Dressing changes
Site assessment
How often are system checks done and how are they performed?
Daily for Heartmate
No system check for HVAD
Hold down the batter button
What is the Pulsatility Index?
The measure of estimated LV contractility and how much volume is pumped with each contraction
Who leads the education given to patients and families and on what topics?
Heart Success Leads education and RNs reinforce with hands of practice (Batteries/connections/dressing changes/medications).
When evaluating program specific performance measures, what is used to compare?
MMC vs. National Average
How are many of the VAD orders placed in EPIC?
The VAD order set, in which many orders are placed as Nursing Communications