1 / 15

Ventricular Assist Device Complications

Ventricular Assist Device Complications. Suzanne Wallace MSN, ACNP-C Northwestern Memorial Hospital Bluhm Cardiovascular Institute September 19, 2009. Early Complications (In hospital). Bleeding Tamponade Arrhythmias Suction Events ARF. Late Complications. Infection RV Failure

kelly-collins
Download Presentation

Ventricular Assist Device Complications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ventricular Assist Device Complications Suzanne Wallace MSN, ACNP-C Northwestern Memorial Hospital Bluhm Cardiovascular Institute September 19, 2009

  2. Early Complications (In hospital) • Bleeding • Tamponade • Arrhythmias • Suction Events • ARF

  3. Late Complications • Infection • RV Failure • Pump malfunction • Thromboembolism • Hemolysis • HTN • CVA – hemorrhagic vs. embolic • GI bleeding/AVMs

  4. Bleeding/Tamponade • Monitor CT output, no anticoag until hemostasis achieved (approx 24hours), monitor Hct – • Other potential sources late: GI, epistaxis, gums etc • Tamponade – typical in hospital first 24-48hrs – may be delayed (ie – w/supratherapeutic INR) • S/S: Hypotension/low MAPs, High CVP, Low Flows, arrhythmias, abrupt cessation of mediastinal CT outtput • Tx: emergent OR, exploration, volume resuscitation

  5. Arrhythmias • VT or VF • S/S: • dizzy, low flows, low PI, low SV, fatigue, palpitations • Etiology: • consider suction event, hemodynamic, lytes • Tx: • Volume resuscitation, anti-arrhythmics (Amio), electrolyte repletion (K > 4, Mg > 2), cardioversion/defib

  6. Suction Events • S/S: • dizziness, low flows, low CVP (may be high with RV dysfunction), arrhythmias(VT), dampened waveforms • Etiology: • hypovolemia, rpm increases, cannula position, RV dysfunction • Tx: • Volume resuscitation, decrease rpms temporarily, treat arrhythmias

  7. Infection • S/S and exam: • Leukocytosis, fever, erythema, drainage, tenderness around driveline site, positve cultures, hyperdynamic flows, hypotension • Etiology: (multifactorial) • Poor dressing technique, improper immobilization of driveline, immunosuppression (ANC < 1000), diabetes, low albumin/poor nutritional status • Tx: • Antibiotics (po/IV depending on severity), Possible OR for exploration, fluid resuscitation, dressing changes/Vacs etc.

  8. RV Failure • S/S: • High CVP, hypotensive, low flows • Dx: • exam, confirm with echo • Etiology: • HTN, volume overload, multiple transfusions • Tx: • Inotropes (Milrinone, Dobut) Diuresis, Adequate ventilation, NO/Vasodilators (Nitrates), RVAD support if severe

  9. Pump Malfunction • Mechanical malfunction – continuous/loud or red alarms on all VADs are BAD!! • Assess pt – 911 if indicated – Call Vad Pager • Etiology: mechanical , thromboembolic events (high pump power) • Change system controller if indicated • Note: if pump stopped > 5minutes(continuous flow) do not attempt to restart – support pt hemodynamically – will get TPA/thrombolytics – prior to restarting pump/going to OR (Directed by VAD implanting Center)

  10. Thromboembolism • Monitor for increasing pump power, look for thrombus (IVAD) • Maintain adequate speeds to maximize pump flow • Proper Anticoagulation – Goal INR 1.7-2.5 for most devices • Notify Vad coordinator – analyze waveforms • Severe – pumps can stop – need urgent OR

  11. Hemolysis • More common on pulsatile VADs • S/S: • Elevated LDH, Plasma Free Hgb, low H/H • Dark urine • Etiology: • Inflow/outflow occlusions, Pulsatile VADs – valves, Liver dysfunction, Multiple transfusions • Tx: • Pulsatile vads: decreasing rate, vaccuum • Continuous Flow VADs: temporarily reduce pump speed, • Transfuse

  12. Hypertension • S/S: • MAPs > 80, SBP > 120-140; Low Flows, High PIs, Possible Headache • Etiology: • Chronic HTN, Volume overload, Pain/Anxiety • Tx: • Antihypertensives: BBlocker ( if No RV- dysfunction), Ace-I (if Crt stable), Hydralazaine, Norvasc • Treat Pain/Anxiety • Diuresis

  13. Stroke • S/S: • HA, slurred speech, visual changes, unilateral weakness, numbness or paresthesias • Etiology: • hemorrhagic vs. thromboembolic – check INR, MAP/BP • Tx: • Medical Emergency: 911 – then Vad coordinator • Tx underlying cause – antihypertensives, give thrombolytics if indicated – (Head CT/Neuro consult) etc..

  14. GI bleeding/AVMs • S/S: • Abdominal pain, low H/H, blood in stool or emesis • Dx: • Colonoscopy, IR, guiac stool • Etiology: • Continuous flow/high pump speed?, supratherapeutic INR, antiplatelet, HIT pts • Tx: • Decrease coumadin dosing, antiplatelet agents, transfuse if indicated, Tx

  15. Summary • Multiple complications possible • Astute assessment skills • Early intervention • Notify Vad coordinator ASAP when complications Arise

More Related