1. Heartware HVAD Ventricular Assist System
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2. About the Pump
Miniaturized circulatory support system for treatment of advanced heart failure
Can achieve up to 10L/min cardiac output
Designed to be placed only in pericardium, no abdominal access as in competitors
FDA approved
Utilized as “Bridge to Transplantation”
and as “Destination Therapy”
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8. Cannulation The inflow cannula is housed within the Pump
Helps decrease pump size
Patient is cannulated in LV apex and Ascending AO
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10. Always defaults to AC/DC power supply if that is plugged in
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17. HeartWare®Back-up Controller
Keep a back-up controller and extra fully charged batteries with the patient at all times in case of an emergency
Verify that the back-up controller parameters match the primary controller parameters
verify by looking at the settings sticker on the backside of the back-up controller
Alarm parameters should be documented on sticker and updated when changed
MD to update sticker when any changes to settings made
The back-up controller should be programmed before the implant procedure, upon any parameter change to the primary controller, and when the primary controller is replaced
Done by MD and documented in note
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26. Only use bags provided from vendor
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32. This will be spot checked on 8E
This will be spot checked on 8E. Patient does not go home with this monitor.
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34. This does not shut down the device
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38. Parameters Monitored Speed = RPMs Work = Watts Flow = Cardiac Output
Normal
(capable of )
Set rate by MD
Measured number
Work = Watts
Measured Number
Alarm should be set 2 greater
than what patient is running at
Flow = Cardiac Output
Calculated Number ( roughly Speed + work + HCT)
Responsible that HCT programmed in device is within 5 of patients current HCT
Alarm should be set 2L/min lower than patient current CO, but never less than 2 L/min
Should be >2 L/min
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39. Management post-operatively and beyond
Control hypertension –maintain MAP < 90mmHg***
Continuous flow pumps are preload dependent and sensitive to increased afterload.
ALWAYS : Consider clinical (patient) related changes when assessing changes in pump flow
Fluids are given to maintain pump flow index at greater than 2.0 L/min/m2 with central venous pressure and left atrial pressure less than 20 mmHg
Vasopressors and/or vasodilators can be used as required to adjust vascular tone
Patients may require inotropic assistance of right ventricular function
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40. Daily Care Essentials
Always ensure that the controller is plugged into two power sources (red outlet on wall + battery or 2 batteries)
A backup controller, programmed to the patient’s current settings, should always be available.
Sticker on back of backup controller with patient information (MR, DOB) and settings
Batteries should be changed when the battery shows 1 bar left (~25% battery life).
Obtaining a blood pressure
Continuous flow device, based on native function, may not have pulsatility
BP obtained via art line tracing or with Doppler + manual cuff
Doppler at brachial pulse to hear continuous flow
Inflate cuff around upper arm
Pressure at which you first hear flow = approximate MAP
Can attempt BP with automated cuff but must confirm with doppler/manual
Attempt pleth measurement if pt has pulsatility
RVAD and BiVAD: Never open venous lines directly to air
No trips to MRI!
Listen & document heart sounds every shift
Notify MD if changes noted
Device is preload-driven:
Consider potential causes for decreased preload:
Tamponade
Hypovolemia
Changes in intrathoracic pressure
Increased PVR
R heart failure
Device is afterload-sensitive, consider potential causes for increased afterload
Pulmonary vs. systemic hypertension
Consider afterload reduction, pulmonary vasodilators, analgesia/sedation
Mobilize pt ASAP 
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41. Nursing considerations
Notify MD of suction events, even if intermittent
Check Alarm Limits (on sticker; changed by MD in system)
High Power alarm 2 watts above average power
Low flow alarm 2L/min below average flow (minimum set 2L/min)
Assure correct HCT is programmed for CO calculation
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42. Arrhythmias/Emergency Procedures
Arrhythmias may occur in the post-operative period
OK to defibrillate HeartWare® System patients
Anti-arrhythmic drugs, pacemakers, and ICDs are compatible with the HeartWare System
Institute appropriate PALS/ACLS protocols
If chest compressions have been administered, confirm function and positioning of HVAD® pump
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43. Anticoagulation
Anticoagulation should be individualized for each patient
In general, begin low-dose heparin at 10 units/kg/hr on postoperative day one
target PTT of seconds
Heparin gtt to be freshly made by Pharmacy and changed Q12 hours
As patients tolerate oral medication, they should be started on warfarin and aspirin
Warfarin should be titrated to maintain the INR of 1.7 to 3
Discontinue heparin when the INR is in therapeutic range. Use low dose
Other Labs:
Unfractionated heparin levels ( )
PTT
TEG
ATIII
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44. Dressing Care Good hand-washing technique
Always use sterile technique: hats, masks & sterile gloves
Initially daily and prn if saturated
After 1 week, QOD and prn
After 14 days, 2 x per week and prn
Dressing:
Cleanse site & surrounding tissue with chlorhexidine 2% wand
Place 2 x 2 gauze over site & cover any area on drive line with exposed velour coating with gauze (tegaderm that is placed directly on velour coating is a significant infection risk)
Cover with tegaderm & date dressing
Securement device needed for drive line
Document in Powerchart
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45. Performs safety checks for Heartware system
At bedside
Back up controller programmed with current patient’s settings
Battery charger with back up batteries charging and labeled
Doppler and manual BP cuff
In Cardiac Storage room, 3rd floor, OR
Surgical Back-up equipment
Drive line extension cable
Outflow graft for pump
Another pump
Necessary surgical insertion tools
2 monitors
4 batteries and battery charger
2 controllers
2 AC adapters
Another patient pack (Velcro holder)
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51. Trouble shooting
Page “LVAD” for heart failure team Heartware 205 Newbury Street, Suite 101 Framingham, MA Hour Clinical Support
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