Transition to Next Level of Care Management of Patient with Ventricular Assist Device Hospital Home Transition

 Long Term Acute Care Hospitals (LTAC)  Acute Rehabilitation (AR)  Sub-acute Rehabilitation (SAR)  Home

 Patients with the following VADs can be safely discharged home: 1. Thoratec PVAD/IVAD on TLC II portable driver 2. Thoratec Heartmate XVE 3. Thoratec Heartmate II 4. Heartware HVAD * These are the common devices currently been implanted in Illinois & Indiana

 Patient/Caregiver Training with return demonstration and written post tests  Supervised and unsupervised excursions  Notification of first responders  EMT  Police  Ambulance service  Notification of local communityhospital  Notification sent to the electric company and request priority power restoration status  Notification of Post Hospital facility or home care services

 General physical condition:  Blood pressure  Heart rate  Temperature  Weight  VAD Function  Record and document the device specific parameters

 Environment  Home  Safety & reliability of electrical system – 3 prong grounded outlets for the power units  Tripping hazards – clutter, loose carpet, pets  Potentially dangerous – swimming pools, open water  Stairs  Location of bedroom, bathroom, shower facilities  Emergency communication capabilities – cell phone, land phone

 Environment  LTAC/Acute Rehab/SAR  Safety & reliability of electrical system – 3 prong grounded outlets for the power units backed by generator  Tripping/Fall hazards – wires, IV poles, furniture  Private room if possible for infection control  Room closer to nurses station to listen and respond to alarm conditions

 Exit Site  Tissue incorporation  Drainage  Surrounding tissue for erythema, swelling, tenderness  VAD Pocket  Fluid over VAD pocket  Skin discoloration or cellulitis  Pain  Blistering  Midline Incision/Scar  Swelling  Blistering  Open blister/drainage  Cellulitis

 Patient comfort with equipment management  Safety issues  Progression with rehab (PT/OT/Speech)  Glucose monitoring  I/O’s  Pressure Ulcers

 VAD patients require close and regular monitoring of labs  CBC  CMP  Magnesium  PT/INR  BNP

VAD patient as an immunosupressed patient !!!!

 Strict hand washing before and after caring for patient.  Follow infection control policy and guidelines of your facility or agency.  Exit site stabilization – abdominal binder  Do not cohort patient with actively infected patient

 Center specific protocol for dressing changes including protective equipment  Hand washing!  Minimize traffic in the room during dressing changes  Sterile/Aseptic dressing changes  Recognize signs & symptoms of infection and report to the VAD team/coordinator immediately!

Supplies  Please provide one week of supplies for patient to go home till outpatient supplies are arranged  Please set up or provide information on ordering wound care supplies prior to discharged from your services  Active involvement of social services

 Daily Aspirin for anticoagulation for all devices  Coumadin is anticoagulation for all devices except Heart Mate XVE  Heart Failure medications  Miscellaneous medications

Key to successful patient outcomes!!  Communicate regularly with the VAD Team on the following:  Abnormal labs  Coumadin dosing  Any change in clinical status  Any signs and/or symptoms of infection  DEVICE ALARMS

All VAD Centers have clinicians providing 24 hour clinical support

Questions????