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

The VAD has four components that

are both internal and external

1.The pump

2.The driveline

3.The controller

4.The batteries

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.

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.

THE CONTROLLERIs 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.

Options for PowerBatteries 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.

If you have a pt with an LVAD make sure you

•Bring their extra batteries•Be sure you have their AC powercord

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

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 alarms3. Find the color tag on the controller so you can identify the

specific device in the ems guide for LVAD devices4. Intervene appropriately based on the type of alarm, color tag

and what the EMS guide says for that VAD5. Initiate IV of NS or LR 6. Assess v/s if possible7. 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.

Cardiac Arrest LVAD PTIf 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.

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.

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.

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.

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.