Bleeding
The most common alarm a patient with a known GI bleed might have
What is a Low Flow Alarm
You are admitting a VAD patient from home. The patient states he changed his driveline dressing that morning and he typically changes it weekly. When would you change the driveline dressing next?
What is within 12 hours of admission
Your VAD patient's urine has changed color. It was dark yellow yesterday, but on assessment this morning the urine is a dark brown tea color. What could this indicate about the patient's pump?
What is pump thrombosis
Quality Measures the VAD team is currently tracking
What is 30 day readmission, 2 year survival, total weight loss for BMI >35, and LOS post implant?
Most common contributing factor to GI bleeds
What is the chronic use of anticoagulants?
Why is it important to ensure the driveline is anchored at all times?
What is any pull to the driveline can result in damage to the tissue = INCREASED r/f infection
You hear an alarm in your VAD patient room. You enter the room to find your patient unconscious and a low flow alarm on their controller. What are your next steps?
1. Is the pump on or off?
2. Call for help (code)
3. Call 803-434-4500
4. Are they breathing? If not, rescue breathing!
5. Do they have a MAP? What is Rhythm?
What are the VAD Clinical Practice Guidelines? How do you find them?
What is? EBP guidelines that outline the management of VAD patients. They are found in the VAD toolkit on Connect.
A VAD patient with a known GI bleed is having a low flow alarm. What are the next steps you need to take?
1. Assess patient - get vitals including doppler MAP
2. Contact VAD team
3. Anticipate drawing labs (H/H) and setting up for blood administration
Your Heartware patient has a controller fault alarm. What do you do? What do you NOT do?
What is
DO call VAD team
DO NOT attempt controller changeout
Your VAD patient falls while ambulating back to bed. The fall was unwitnessed. What do you need to assess and anticipate orders for?
What is a thorough neuro assessment, assess rhythm at time of fall, assess for any other injuries/bruising (think hematoma!), and anticipate a CT scan of the head to assess for bleeding.
Your VAD patient has orange tape on their power connection cables. What does this indicate?
What is? Short to shield driveline
Who manages the VAD patient's anticoagulation regiment?
The VAD team & VAD clinical pharmacist
List possible causes for Low Flow alarms.
What is Hypovolemia, Hypertension, Bleeding, Arrhythmias, Tamponade, Pump Thrombosis, RV Fail, Inflow obstruction, EOGO!
Your VAD patient has been admitted d/t a GI bleed. During your morning rounds, you are called to their room and find the patient c/o blurred vision. What are you focused on assessing and why?
What is full neuro assessment d/t risk for stroke
What is short-term VAD therapy versus long-term VAD therapy? How do you know which one your patient is?
What is? Short-term = patients that are candidate for heart transplant
Long-term = patients that are not candidates for heart transplant
You can find this info for your patient in the progress note
The risk of low INR
The risk of high INR
Low: What is development of clots (pump thrombosis, ischemic strokes, atrial fibrillation)
High: What is excessive bleeding and serious complications (hemorrhagic stroke)
The LVAD is ______ dependent and ______ sensitive.
What is preload dependent and Afterload sensitive
Your Heartmate II patient has a red heart alarm with flow indicating --- and a red banner. What does this indicate? What would you do?
What is the numerical flow cannot be assessed because it is outside of the algorithm however the flow is less than 2.5 L/min.
Assess your patient. Vital signs. Call 803-434-4500
What is competency level 1