Clinical assessment of pulsatile and non pulsaltile vads
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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 l.jpg

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 l.jpg
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


Types of vads l.jpg

Pulsatile VADs

Thoratec PVAD

Thoratec IVAD

HeartMate XVE

Non-Pulsatile VADs

HeatMate II

HeartWare HVAD

Types of VADs


Pulsatile vads l.jpg
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


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Blood Pressure

  • Ideal BP <120/

  • If pt is hypotensive then

    • ? Volume depleted

    • Bleeding

    • Arrhythmias

    • ? RHF if LVAD


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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


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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


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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


Arrhythmias9 l.jpg
Arrhythmias

  • EKG – Identify electrical rhythm

  • Okay to cardiovert/defibrillate

  • If RPMs too high could have

    “suction events”

  • No Hand Pump

  • Caution with CPR


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Basic Clinical Assessment

  • Neuro-Mental Status

  • Peripheral Circulation-warmth

  • Skin color

  • Respiratory status

  • Labs if available

  • ? VAD alarms


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Assess VAD Function

  • VAD alarms

  • VAD readings/parameters



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