The document discusses ventricular assist devices (VADs) which are mechanical pumps that help the heart pump blood. The most common type is the left ventricular assist device (LVAD) which takes blood from the left ventricle to the aorta. An LVAD has internal and external components including a pump, driveline, controller, and batteries. LVADs are used to bridge patients to transplant, rest the heart after procedures, or as destination therapy for those not eligible for transplant. When assessing a patient with an LVAD, listen for pump sounds, check for alarms, treat abnormalities per protocols while being aware of the unique considerations for a patient with a VAD.

2. OBJECTIVES
Understand the types of VADs
Describe indications for and
components of a ventricular assist
device.
Discern assessment findings of pts with
a VAD from other emergency pts
Be proficient in the care of a pt with a
VAD

3.  A mechanical circulatory assist device that is used to support
heart function and blood flow in people who have weakened
hearts. Most common are LVADS (left ventricular assist
device) there are also RVADS (right ventricular assist device)
and BIVAD (biventricular assist device).
 The LVAD takes blood from the left ventricle to the aorta and
then to the body and vital organs, just as a normal healthy
heart would.
 The RVAD takes the blood from the right ventricle pump blood
to the pulmonary artery. This is the artery that carries blood
from the heart to the lungs to pick up oxygen.
 A BIVAD might be used if both ventricles don't work well
enough to meet the body's needs. Another treatment option for
this condition is a total artificial heart.

4.  The LVAD device was FDA approved in the US in 2010
for 3 situations.
 1. "Bridge to Transplant" for those patients awaiting a
heart transplant
 2. To "rest" a damaged left ventricle after a surgical
procedure, or major heart attack.
 3. "Destination Therapy" for those who have severe
end stage heart failure, but are not candidates for a
heart transplant

5. Mechanical device
Surgically implanted
Improves cardiac output
Most common type LVAD
Shands is our closest VAD center
They use the Heartmate 2 most
commonly

6. An LVAD has four components that
are both internal and external
1.The pump
2.The driveline
3.The controller
4.The batteries

7. 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.

8. The
Driveline
The driveline is
internal and
external. It is a
percutaneous lead
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.

9. 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.

10. 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.

11. In shortIf you
have a pt with
an LVAD make
sure you
•Bring their
extra
batteries
•Be sure
you have
their AC
power cord

12. LVADS can
be pulsatile
or
continuous
flow
Continuous
flow LVADs
you will not
feel a pulse
and may not
be able to
obtain a b/p

13. 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

14. PULSE OX MAY NOT DETECT AN O2 SAT

15. To assess specifically for the
VAD
1. Auscultate 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 one with the
NIBP then us the MEAN of that.
8. You may or might not be able to detect a b/p which can be
normal. Pulse also may or may not be palpable.

16. Best indicator with LVAD pts is:
Their LOC and
the skin color
and condition.

17. 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.

18.  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 but be mindful that pt may be on viagra
to reduce chances of right heart failure (male or female).
 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 improving . Be sure to continuously check
lung sounds and watch for signs of CHF. If pt starts to have signs
of CHF discontinue fluid bolus. Pt will have a low or no b/p
reading DO NOT treat the b/p. Treat the PT not the monitor.

19. 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.

20. 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.

21. Special Considerations
1. Be careful not to twist, cut or bend the
driveline coming out of the abdomen (this is
the lifeline and if it disconnects they will die).
2. Most common complications are bleeding
and thromboemboli
3. Do not get tunnel vision, LVAD pts will call
for reasons unrelated to their LVAD
4. It is possible for pt to be in VF or VT and be
awake, alert and talking

22. Treat dysrhythmias in accordance with
the appropriate dysrhythmia protocol