Ventricular Assist Devices - Revision history

Mfrdmanager at 13:45, 13 November 2020

2020-11-13T13:45:28Z

Mfrdmanager: /* 4.14 VENTRICULAR ASSIST DEVICES */

2018-08-03T19:34:26Z

‎4.14 VENTRICULAR ASSIST DEVICES

Mfrdmanager: Protected "Ventricular Assist Devices" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

2018-02-10T14:10:29Z

Protected "Ventricular Assist Devices" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

Mfrdmanager: Created page with "==Section 4 - CARDIAC== ===4.14 VENTRICULAR ASSIST DEVICES=== This Parameter applies to the management of patients who have a ventricular assist device (VAD) also referred to..."

2018-02-10T14:10:23Z

Created page with "==Section 4 - CARDIAC== ===4.14 VENTRICULAR ASSIST DEVICES=== This Parameter applies to the management of patients who have a ventricular assist device (VAD) also referred to..."

New page

==Section 4 - CARDIAC==
===4.14 VENTRICULAR ASSIST DEVICES===

This Parameter applies to the management of patients who have a ventricular assist device (VAD) also referred to a left ventricular assist device (LVAD) implanted. The VAD is a mechanical pump used to support the heart’s pumping function and positive blood flow on individuals who have severe heart failure.

[[Initial Medical Assessment and Care|INITIATE MEDICAL CARE (2.01)]]
* Perform initial assessment: vital signs, oxygen saturation, pre-treatment 12-Lead ECG, focused history (SAMPLE, OPQRST), and physical exam. Inquire if the patient has an old ECG.
** Provide OXYGEN @ 100% via NRB mask or assist ventilations/oxygenation as indicated.
* Listen to heart sounds. The heart sounds may be faint.
* '''Check for a functioning VAD''': These devices are usually implanted below the heart in the abdominal cavity area. Use a stethoscope to listen for constant humming or whirling sound. This sound confirms the VAD is functioning.
** The nature of the VAD function provides positive constant flow (it is a centrifugal pump) therefore '''a pulse may not be palpable''' in these patients.
* '''Blood Pressure''': A manual blood pressure may not be obtainable. An automated blood pressure monitoring device may provide a reading with a narrow pulse pressure.
** Treatment of these patients must be based on the mean arterial pressure (MAP). The normal MAP should be between 60 and 90 mm/Hg.
* '''Pulse Oximetry''': These readings may not be accurate due to the continuous flow provided by the VAD.
** Monitor side capnography for ventilation and oxygenation effectiveness.

'''UNRESPONSIVE PATIENT'''
* If the patient is unresponsive to stimuli:
** Open the airway and ventilate/oxygenate as necessary.
** Obtain a blood glucose level and treat per [[Hypo or Hyperglycemia|5.10 Hypoglycemia]] parameter as needed.
* Listen for a functioning VAD by auscultating over the abdomen.
** If the VAD has a whirling sound it is properly functioning.
** '''DO NOT PERFORM CPR!'''
*** A VAD or LVAD is surgically implanted to the left ventricle. External cardiac compressions may dislodge the VAD causing death.
* If the VAD is silent have the caregiver or family member check the device external pump controller and power supply.
** '''LISTEN TO THE CAREGIVER!''' These individuals are experts in these devices and know/understand how to operate and troubleshoot the system.
** VAD patients are instructed to always have a backup bag with 2 charged batteries and a second pump controller.
** Contact the LVAD coordinator on call (based at Florida South).
* If the VAD is inoperative despite troubleshooting and battery replacement, then CPR is indicated as per cardiac arrest parameter.

'''RESPONSIVE PATIENT:'''
* Perform a subjective interview to determine chief complaint and history of present illness.
* Monitor ECG and obtain a 12 lead ECG if chest pain, ischemic symptoms, shortness of breath or weakness is reported.
** Any cardiac dysrhythmias must be treated per the appropriate practice parameter.
** If electrical therapy is indicated on a conscious patient, the patient may be sedated (time permitting) as per parameter 2.04 Analgesia/Sedation.
* Establish IV access and provide fluid resuscitation as indicated based on patient’s condition and hydration status.
* Assess for any other concurrent medical conditions or symptoms and treat per the appropriate parameter.

'''TRANSPORT OF PATIENT:'''
* '''ALL VAD patients with cardiac, respiratory, neurological or infectious disease complaints must be transported to the VAD center.'''
** Currently Florida Hospital Orlando is the only local approved VAD center.
** Contact the VAD coordinator as soon as possible and notify them of the transport.
*VAD patients presenting with minor complaints may be transported to any receiving facility as long as they have their backup batteries and equipment with the patient.
** These complaints include, but are not limited to:
*** Minor sprains, strains or orthopedic injuries
*** Hypoglycemia without severe signs or symptoms
*** Isolated extremity lacerations
* Don’t forget the family member/caregiver!
** The family member/caregiver must '''ACCOMPANY''' the patient in the ambulance.
** These individuals have intimate knowledge of the patient’s condition, the system and usually have legal authority to sign on behalf of the patient.
* '''Bring all VAD equipment, backup bags, charger and batteries with the patient!'''

[[Category:Cardiac|0414]]

@@ Line 6: / Line 6: @@
 [[Initial Medical Assessment and Care|INITIATE MEDICAL CARE (2.01)]]
 * Perform initial assessment: vital signs, oxygen saturation, pre-treatment 12-Lead ECG, focused history (SAMPLE, OPQRST), and physical exam. Inquire if the patient has an old ECG.
-** Provide OXYGEN @ 100% via NRB mask or assist ventilations/oxygenation as indicated.
+** Provide [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist ventilations/oxygenation as indicated.
 * Listen to heart sounds. The heart sounds may be faint.
 * '''Check for a functioning VAD''': These devices are usually implanted below the heart in the abdominal cavity area. Use a stethoscope to listen for constant humming or whirling sound. This sound confirms the VAD is functioning.

@@ Line 28: / Line 28: @@
 ** VAD patients are instructed to always have a backup bag with 2 charged batteries and a second pump controller.
 ** Contact the LVAD coordinator on call (based at Florida South).
-* If the VAD is inoperative despite troubleshooting and battery replacement, then CPR is indicated as per cardiac arrest parameter.
+* If the VAD is inoperative despite troubleshooting and battery replacement or if crews are unable to verify if the VAD is working, then CPR is indicated as per cardiac arrest parameter.

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