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Clinical Assessment of Pulsatile and Non-Pulsaltile VADs

Clinical Assessment of Pulsatile and Non-Pulsaltile VADs. Diana Joseph RN, BSN, CCTC VAD/Heart Transplant Coordinator OSF St. Francis Medical Center Peoria, IL. Pulsatile Flow. Contraction or beating of the heart as felt through the walls of the arteries Normal patients: Pulse is accurate

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Clinical Assessment of Pulsatile and Non-Pulsaltile VADs

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  1. Clinical Assessment of Pulsatile and Non-Pulsaltile VADs Diana Joseph RN, BSN, CCTC VAD/Heart Transplant Coordinator OSF St. Francis Medical Center Peoria, IL

  2. Pulsatile Flow Contraction or beating of the heart as felt through the walls of the arteries • Normal patients: Pulse is accurate • VAD patients: Not truly feeling pts heartbeat. Asynchronous to electrical rhythm

  3. Pulsatile VADs Thoratec PVAD Thoratec IVAD HeartMate XVE Non-Pulsatile VADs HeatMate II HeartWare HVAD Types of VADs

  4. Pulsatile VADs • Fixed or Auto mode • Preload sensitive/Volume dependent • Radial pulse felt is the actual VAD pumping rate • VAD rate/flows increase with activity, volume, sepsis • VAD rate/flows decrease with rest, hypovolemia, arrhythmias, RHF

  5. Blood Pressure • Ideal BP <120/ • If pt is hypotensive then • ? Volume depleted • Bleeding • Arrhythmias • ? RHF if LVAD

  6. Arrhythmias • EKG-The only true way to identify pt’s true electrical rhythm • VAD rate/pulse is asynchronous to pt’s electrical activity • Atrial Fibrillation • Ventricular Tachycardia • Ventricular Fibrillation • Majority of pts will have AICD/Defibrillators

  7. Cardioversion/Defibrillation • Most VAD pts will tolerate arrhythmias • Assess pt if hemodynamically stable • Okay to cardiovert/defibrillate • No CPR: Could possibly damage or dislodge cannulas/tubings resulting in fatal internal bleeding • Hand Pump

  8. Non-Pulsatile VADs • Axial/Continuous Flow • RPMs • Difficult to obtain a pulse or BP • Use a doppler for BP (narrow pulse pressure) • Ideal MAP >70 • Most pts will have some residual rhythmic contraction thus create a pulse

  9. Arrhythmias • EKG – Identify electrical rhythm • Okay to cardiovert/defibrillate • If RPMs too high could have “suction events” • No Hand Pump • Caution with CPR

  10. Basic Clinical Assessment • Neuro-Mental Status • Peripheral Circulation-warmth • Skin color • Respiratory status • Labs if available • ? VAD alarms

  11. Assess VAD Function • VAD alarms • VAD readings/parameters

  12. QUESTIONS ???

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