Clinical Assessment of Pulsatile and Non-Pulsaltile VADs Diana Joseph RN, BSN, CCTC VAD/Heart Transplant Coordinator OSF St. Francis Medical Center Peoria, IL

Pulsatile Flow

Contraction or beating of the heart as felt through the walls of the arteries   Normal patients: Pulse is accurate VAD patients: Not truly feeling pts heartbeat. Asynchronous to electrical rhythm

Types of VADs

Pulsatile VADs

   Thoratec PVAD Thoratec IVAD HeartMate XVE  

Non-Pulsatile VADs

HeatMate II HeartWare HVAD

Pulsatile VADs

     Fixed or Auto mode Preload sensitive/Volume dependent Radial pulse felt is the actual VAD pumping rate VAD rate/flows increase with activity, volume, sepsis VAD rate/flows decrease with rest, hypovolemia, arrhythmias, RHF

Blood Pressure

  Ideal BP <120/ If pt is hypotensive then  ? Volume depleted    Bleeding Arrhythmias ? RHF if LVAD

Arrhythmias

   EKG-The only true way to identify pt’s true electrical rhythm VAD rate/pulse is asynchronous to pt’s electrical activity  Atrial Fibrillation   Ventricular Tachycardia Ventricular Fibrillation Majority of pts will have AICD/Defibrillators

Cardioversion/Defibrillation

     Most VAD pts will tolerate arrhythmias Assess pt if hemodynamically stable Okay to cardiovert/defibrillate No CPR: Could possibly damage or dislodge cannulas/tubings resulting in fatal internal bleeding Hand Pump

Non-Pulsatile VADs

    Axial/Continuous Flow RPMs Difficult to obtain a pulse or BP  Use a doppler for BP (narrow pulse pressure)  Ideal MAP >70 Most pts will have some residual rhythmic contraction thus create a pulse

Arrhythmias

     EKG – Identify electrical rhythm Okay to cardiovert/defibrillate If RPMs too high could have “suction events” No Hand Pump Caution with CPR

Basic Clinical Assessment

      Neuro-Mental Status Peripheral Circulation-warmth Skin color Respiratory status Labs if available ? VAD alarms

Assess VAD Function

 VAD alarms  VAD readings/parameters

QUESTIONS ???