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University of Kentucky Cardiac Rehab for Mechanic Circulatory Support Program

University of Kentucky Cardiac Rehab for Mechanic Circulatory Support Program. Mark Bradley RN Tiya Carson PT, DPT. Objectives. Understand the precautions used with mechanical circulatory devices and rehab intervention.

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University of Kentucky Cardiac Rehab for Mechanic Circulatory Support Program

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  1. University of KentuckyCardiac Rehab for Mechanic Circulatory Support Program Mark Bradley RN Tiya Carson PT, DPT

  2. Objectives • Understand the precautions used with mechanical circulatory devices and rehab intervention • Discuss appropriate treatment plans for clients with mechanical circulatory device • Discuss appropriate education to clients and families regarding activity level and community outreaches

  3. Components of the HMII • Implantable titanium blood pump • System Controller • Power Module • Batteries & Clips

  4. VAD Specific Anticoagulation ASA 81mg Persantine 75mg TID Warfarin for INR target of 2.5 with range of 2.0-3.0

  5. VAD Specific Hemodynamics

  6. Physiological Differences • Weak or absent Pulse! • Most patients will not have a pulse • The ventricle is unloaded before enough pressure is generated to open the aortic valve

  7. Physiological Differences • Weak Pulse Oximetry • Weak or no pulse • Not accurate

  8. Physiological Differences • Blood pressure: • will have a narrow pulse pressure • Most patients do not have a audible blood pressure • Need to use Doppler • Measure the MAP

  9. Speed 9,200 rpm (8,000 – 13,000) Flow mean 5.5 lpm (2.5 – 10.0) Typical Pump Parameters

  10. EmergentPatient Management

  11. Ventricular Assist DevicesThis is an “Assistive” Device only;not a replacement for the Heart. If the pump fails the patient still has native heart function.

  12. VAD Complications • Right Heart failure • Bleeding • Arrhythmia • Infection • Hemolysis • Thromboembolism

  13. Initial Assessment Treat the patient; not the equipment Follow ACLS Guidelines: Treat dysrhythmia only if symptomatic Dysrhythmias can effect pre-load & VAD Flows Treat the symptomatic VAD as a Heart Failure Patient OK to use Inotropes & presser's as needed

  14. Defibrillation / Cardioversion Do not stop the pump Follow ACLS Guidelines Controller and pump are isolated and grounded

  15. Chest Compressions Is the patient Pink, Warm and Dry or blue? Listen to Apex of Heart for humming sound to verify is pump is running If the controller is not alarming and no red lights, no alarms; then the pump is running When in doubt about the performance of the pump or if the patient appears to be symptomatic, do chest compressions.

  16. Future of MCS: HeartWare

  17. HeartMate III

  18. Wireless VADs

  19. LVAD Precautions • Sternal Precautions (4-6 weeks) • Secure all parts • No overly vigorous activity • Monitor Vital Signs • Monitor Tolerance • Rate Perceived Exertion Scales (Borg) • Dyspnea Scales

  20. HeartMate II Alarms • Intermittent beep: Cautionary audible alert • One battery is disconnected • Time to change batteries or return to Power Module • Continuous blaring sound: either pump has stopped or pump flow is greatly reduced. • Both power sources are disconnected • Pump failure • Low Systemic Volume

  21. Terminate session if:

  22. Terminate session if: • Dizziness, diaphoresis, or fainting occur • Severe, intolerable dyspnea • Significant pain • Extreme fatigue • Request of patient to stop

  23. Treatment Precautions for MCS • Patient/ family must have all supplies for rehab • Do NOT initiate treatment if: • Back-up device • Batteries • Back-up batteries • Nitro • Are not available

  24. Treatment Precautions for MCS • Blood pressure • If you are not able to get a blood pressure this is not necessarily a contraindication to treatment • LVAD = you are effectively reducing the load to the ventricles • TAH = blood pressure is accurate • Assess the patient • Should be pink, dry, and mentating

  25. Therapeutic Interventions • Activity tolerance • Aerobic activity • Strengthening • Core Stability • Balance

  26. Activity tolerance • Goals: To increase aerobic capacity • Options: Over-land walking, treadmills, bicycles, upper extremity ergometer, Elliptical machines

  27. Strengthening • Goals: To increase muscle mass and muscular stability • Options: Resistance bands, free weights, light weight machinery

  28. Core Stability and Balance • Goals: retrain key support muscles that were possibly affected from surgery to gain maximum functional mobility • Options: balance balls, foam rollers, Bosu balls, mat work, Yoga, Pilates, Tai Chi, Wii fitness, stretching

  29. Outpatient Rehab • Progress strengthening, transfers, gait training, aerobic conditioning, and education • At Discharge: Should be completely independent and functional within the home and community

  30. Education • Patients should be doing as much as they can!!! • Walking everyday • Participate in Rehab Program • Getting out of the home and back into community • Families should encourage activity • No swimming or submersion underwater • No vigorous/ jarring

  31. Questions???

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