It's Complicated!
The most common alarm a patient with a known GI bleed might have
What is a Low Flow Alarm
You connect your Heartmate II patient to wall power and the LVAD alarms low flow with no green arrows? What happened?
What is? The pump stopped because the patient had a short to shield.
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, implanting more Intermacs 3/4 patients, and referring patients to heart transplant within 18 months of implant.
Hypertension, low volume, arrhythmias
What are most common causes of low flow alarms?
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 find your patient unconscious and a low flow alarm on their controller. How can you verify that the pump is on?
What is: Look for the green arrows (circle of life) and/or auscultate for LVAD hum.
What is competency level 1
Coughing, sneezing, arrhythmias, sudden changes in volume status.
What are triggers for a PI event?
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 patient is unconscious and you have verified that the pump is off. What is your next step?
What is begin chest compressions and call adult medical emergency then notify the VAD team.
Who manages the VAD patient's anticoagulation regiment?
The VAD team & VAD clinical pharmacist
The patient's speed has been increased from 5000 to 5200. How do you expect the flow to respond?
What is increase?
Your Heartmate 3 patient was admitted for a GI bleed. They are now complaining of a severe headache. What are your concerns? What would you do?
Possible head bleed
Notify LVAD team
Anticipate CT scan
List possible causes for Low Flow alarms.
What is Hypovolemia, Hypertension, Bleeding, Arrhythmias, Tamponade, Pump Thrombosis, RV Fail, Inflow obstruction, EOGO!
Your VAD patient is unconscious, and you have verified the pump is on, what is your next step?
What is?
Call an adult medical emergency
Call the LVAD team
Hold chest compressions
What type of LVADs require verification of pump settings on the backup controllers?
What is Heartmate II and Heartware?
The patient's fixed speed is 5200 rpms. The physician changes the speed to 5100 rpms. What should the new low speed limit be?
What is 4700 rpms.
Your Heartmate II patient's power was averaging 5. Now it's 10 watts. There have been no changes to the patient's speed. What could this indicate?
What is pump thrombosis?
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
When is the next LVAD Joint Commission survey due?
What is fall of 2027?
On a Heartware patient how do you assess the pulsatility?
What is the difference in the peak and trough waveform values.