1. Community Preparation for Caring for Mechanical Circulatory Device Patients University of Wisconsin Hospital And Clinics Ventricular Assist Device Program

2. Mechanical Circulatory Support Device Overview MCDSs are devices to support the failing heart (one side or both) Most MCDS patients are anticoagulated with Coumadin and Aspirin All MCDSs have: – Pump (implanted inside the patients chest) – Computer to control the settings/ display VAD performance readings – Power source: batteries or console connected to AC power

3. Components VAD readings Care Overview Emergency Care

4. Thoratec TLC-II Can be used for RV, LV or both Can be implanted or paracorporeal Pulsatile VAD (can hear it running) Sterile dressing over cannula exit sites Each VAD has 2 mechanical valves

5. Thoratec TLC-II VAD Components Inflow cannula Outflow cannula

6. Thoratec TLC-II Control Panel

7. Thoratec TLC-II Care Overview Can palpate a pulse Need to assess if pump if running: listen for mechanical valve clicking and the noise of console working (BOTH NEED TO BE HEARD) Blood pressure: – Keep SBP< 140 – Non-invasive blood pressure cuffs will work

8. Thoratec TLC-II Care Overview (contd) EKG conduction is not affected and arrhythmias maybe tolerated including VT/ VF – Most of these patients have an ICD/ pacer. Some patients ICDs are off to avoid inappropriate shocks. – Most VAD patients tolerate the arrhythmias and may have little symptoms for period of time. Assess for patients tolerance of situation (if able). Ask for symptoms: lightheadedness, shortness of breath, palpitations, bloating, pain (anywhere), fever, chills, diaphoresis

9. Emergency Care- Thoratec VAD stopped (listen for valve clicking and console running). If stopped significant risk for clot inside MCDS and thromboembolize. NO CHEST COMPRESSIONS Defibrillation- STANDARD METHOD Heparin bolus if VAD stopped (contact attending cardiac surgeon) Hand pumps can be used in case of console failure. RVAD needs to be pumped < then LVAD.