The Left Ventricular Assist Device (LVAD) is a mechanical pump that takes blood from the left ventricle of the weakened heart and pumps it to the body, similar to a normal heart. The LVAD has four main components - an internal pump, internal/external driveline, external controller, and batteries. The pump is placed in the heart and connected to the ventricle and aorta. The driveline connects the pump to the controller. The controller operates and monitors the pump. Batteries power the device and must be recharged. When assessing a patient with an LVAD, listen for pump sounds, check for alarms, identify the device type, treat any medical issues, and transport
2. The Left Ventricular Assist Device is a type
mechanical circulatory assist device that is used to
support heart function and blood flow in people who
have weakened hearts.
The device takes blood from the left ventricle to the
aorta and then to the body and vital organs, just as a
normal healthy heart would
3. The VAD has four components that
are both internal and external
1.The pump
2.The driveline
3.The controller
4.The batteries
4. The pump is internal It
is connected to your
left ventricle that pulls
blood into the pump
which then sends the
blood to the acending
aorta which sends the
blood to your body with
your heart having to do
minimal work.
5. The
Driveline
The driveline is
internal and
external. It is a tube
that connects the
pump to the
controller. It
contains necessary
power and
electronic cables. It
exits through the
skin, on either the
right or left side of
the abdomen.
6. THE CONTROLLER
Is external and it operates the pump and has lights,
messages, and/or alarms if the power is low or if it is not
functioning properly. It can be worn around the waist or
over the shoulder. Look at the color of the tag on the
controller so you can refer to the EMS guide on how to treat
your pt with that specific
VAD.
7. Options for Power
Batteries AC power sources
The batteries are charged using
a device specific battery charger.
The controller and/or batteries
will show you how much power
the batteries have left and alert
you when they need to be
changed. When the patient is
outside of their home they need
to have extra fully charged
batteries with them. Depending
on their specific VAD device, the
batteries may be in a pack along
with the controller or carried in
a holster over their shoulders.
When the patient sleeping or
about to sleep, they need to
connect the VAD to the device-
specific electrical power source
to eliminate the chance of
battery power loss while
sleeping. The electrical power
source should include a backup
battery (possibly internal) in
case there is a power outage. The
device may also come with a DC
adaptor, which will allow them
to power their VAD in a car.
8. If you have
a pt with an
LVAD make
sure you
•Bring their
extra
batteries
•Be sure
you have
their AC
powercord
9. When assessing a pt with an LVAD
start with your normal assessment
intervene as necessary
Initial
assessment
• Airway
assessment
• Attach cardiac
monitor and
pulse ox
10. Then assess specifically for
the VAD
1. Aucultate heart sounds to determine if the device is
functioning. If it is a continuous flow device you should hear a
“whirling sound”
2. Assess the device for any alarms
3. Find the color tag on the controller so you can identify the
specific device in the ems guide for LVAD devices
4. Intervene appropriately based on the type of alarm, color tag
and what the EMS guide says for that VAD
5. Initiate IV of NS or LR
6. Assess v/s if possible
7. Optimal way to assess v/s is us the mean b/p with a doppler if
no doppler is available and you are able to obtain on with the
NIBP then us the MEAN of that.
8. You may or may not be able to detect a b/p. If you cannot you
will instead rely on the pts LOC and the skin color and
condition. Pulse may or may not be palpable.
11. Cardiac Arrest LVAD PT
If your pt is unconscious,
unresponsive to stimuli and
pulseless listen to the pts chest. If
you hear the whirling sound of the
LVAD, DO NOT PREFORM CPR. If
you cannot hear the device then
CPR should be performed per
cardiac arrest protocol.
12. Yes you can do a 12 lead and defibrillate as you would given
the situation
Treat all STEMI and chest pain complaints as you would
using the Chest Pain Protocol
Transport to closest VAD center if possible, otherwise to
the closest hospital if pt is hemodynamically unstable or to
the hospital of choice if pt is stable.
If you suspect the pt is dehydrated bolus 250cc of NS with a
max of 500cc until pt is normotensive . Be sure to
continuously check lung sounds and watch for signs of
CHF. If pt starts to have signs of CHF discontinue fluid
bolus.
13. LVAD pt should have all
medications that a non LVAD
pt with heart failure would
have including blood
thinners to help prevent the
development of clots.
14. When taking care of a pt always
remember:
ALL VAD pt and their families/caretakers
have been well educated on the VAD and the
care along with it. If you have any questions
ask the pt or the family. If it is an emergent
situation or the pt is unable to answer
questions bring a family member with you.
15. More information on pts with a VAD
Some complications pts can have when they have a VAD
can be but are not limited to driveline infections, pump
clotting or device failure.
The type of pts that have VADS or that can receive a VAD is
pts with advanced heart failure not responding to optimal
medical management, pts waiting to get a heart transplant,
or pts with end-stage heart failure used as “destination
therapy” when they are not transplant candidates
There is no weight limit for pts to receive a VAD however
the ideal BMI is below 35.
Pts who have a VAD can extend their life up to 7 years or
longer than if they did not have it.