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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

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
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
Pulsatile VADs

Thoratec PVAD

Thoratec IVAD

HeartMate XVE

Non-Pulsatile VADs

HeatMate II

HeartWare HVAD

Types of VADs
pulsatile vads
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
blood pressure
Blood Pressure
  • Ideal BP <120/
  • If pt is hypotensive then
      • ? Volume depleted
      • Bleeding
      • Arrhythmias
      • ? RHF if LVAD
arrhythmias
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
cardioversion defibrillation
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
non pulsatile vads
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
Arrhythmias
  • EKG – Identify electrical rhythm
  • Okay to cardiovert/defibrillate
  • If RPMs too high could have

“suction events”

  • No Hand Pump
  • Caution with CPR
basic clinical assessment
Basic Clinical Assessment
  • Neuro-Mental Status
  • Peripheral Circulation-warmth
  • Skin color
  • Respiratory status
  • Labs if available
  • ? VAD alarms
assess vad function
Assess VAD Function
  • VAD alarms
  • VAD readings/parameters
ad