1. Ventricular Assist Device
VAD

2. Objectives Indication of a Ventricular Assist Device (VAD)
Functions of a Ventricular Assist Device (VAD)
Assessing patients with a Ventricular Assist Device (VAD)

3. Ventricular Assist Device (VAD)
Is a mechanical pump utilized when one of the heart’s natural pumps (a ventricle) does not perform well
Is used to increase the amount of blood flow through the body

4. The parts of a VAD A pump attached to one of the body’s ventricles
An external controller that monitors the pump
A driveline cable that connects the pump to the controller
Power sources to run the pump and controller

5. How it works
Surgically implanted in the chest in the pericardial space
The pump is connected directly to the heart at the bottom left ventricle
The pump draws oxygen rich blood through it and pushes it into the aorta where it flows to the rest of the body
The driveline connects to the pump and exists the body through a small incision connection to the controller

6. Who needs it?
Typically given to patients awaiting a heart transplant as a temporary solution (“bridge to transplant”)
Can be used to strengthen other body systems before making a transplant decision (“bridge to candidacy” or “bridge to decision”)
Can be a permanent treatment when transplant is not an option
Can be temporary until the heart heals (“bridge to recovery”)

7. Risks of a VAD Blood clots – patients may be on blood thinners
Bleeding
Infection- the skin is open for connections
Device Malfunction-requires immediate medical attention
Right Heart Failure-a left ventricle device may pump more than the heart is used to which leaves the right ventricle too weak to pump the increased volume

8. What if the patient has no pulse?
Patients with a VAD will not have a palpable pulse
Check your rhythm and call their “VAD coordinator”
The patient will have a wallet card or ask their family
If unable to contact the VAD coordinator, contact your medical control

9. Assessment
Be extremely careful not to cut, bend, or twist the driveline (remember this connects the power source to the pumps)
Start with the ABC’s but “C” will be slightly different
You will not be able to palpate a pulse or get a manual blood pressure
You might get a pressure with a NIBP or Doppler
Pulse ox readings will most likely be inaccurate
Assess mental status, skin and lips for oxygenations status
Listen over the lower left anterior rib margin for a hum indicating the pump is running

10. Alarms from the VAD
Make sure the driveline and two power sources (dual batteries or AC power) are connected to the system controllers
If you transport-make sure your rig has a working invertor
If the pump malfunctions-the patient will go back into failure which may or may not be tolerated

11. The VAD Stopped Working
DO NOT restart the unit unless told to do so by the VAD coordinator
Restarting will increase the risks of stroke or clots because there could be stagnant blood in the system

12. Should I do an EKG?
Yes – BUT...assess the rhythm and tell the VAD coordinator before you initiate any treatment

13. Can I defibrillate? If you need to defibrillate or cardiovert you can
Just make sure the pad is not over the pump
It is acceptable to place the pads anterior/posterior
DO NOT stop the VAD to deliver a shock
Confirm cardiac arrest before you start CPR and get guidance from the VAD coordinator (poor perfusion of skin, complete lack of responsiveness and indications the pump is not functioning)

14. Don’t get distracted!
The call may have been for something other than the VAD
Base your interventions on your protocols but discuss your plans with the VAD coordinator

15. For more information:
device/home/ovc
care/patients-ventricular-assist-device-need.html