LVAD Assessment, Management and

Maintenance in the Home

Victoria C. E. CrawleyNUR/590B

University of Phoenix

Goal and ObjectivesGoal: Students will be competent in the

assessment, management and maintenance of the LVAD patient in the home.

Objectives: By the end of this course:Students will be able to describe basic

components of LVAD technology. Students will be able to identify and implement

the various stages of the Roper-Logan-Tierney Model of Living.

Students will demonstrate application of the Roper-Logan-Tierney Model when caring for the LVAD patient.

Students will express various complication prevention techniques with LVAD technology.

Course OutlineIntroduction

History of the LVADLVAD

Technology basicsPlacementUses Potential Complications

Course OutlineThe Roper-Logan-Tierney Model of Living

The 12 components:Maintaining a Safe EnvironmentCommunicationBreathing Eating and DrinkingEliminationWashing and DressingControlling TemperatureMobilizationWorking and PlayingExpressing SexualitySleepingDeath and Dying: Ethical Considerations

Course OutlineThink-Pair-Share

Find a partnerDiscuss two scenarios

DiscussionSharing of thoughts from Think-Pair-

ShareQuestion and Answer Session

Write down any questions you may have during the presentation and save for the end of the class.

IntroductionOrigins of the LVAD

Indications Nurses Role in Care

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What is an LVAD? A Refresher

Available for patients with severe myocardial infarct by which the heart cannot sustain itself

Available for chronic CHF patients for which treatments are no longer an option

Implantable device Portable Prolongs life by up to 3-5 years

LVAD UsesBridge to recoveryBridge to transplantation Destination therapy

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Placement and Equipment

Photo Credit: www.mylvad.com

Potential Complications: an Overview

Pump malfunction Impaired renal function GI bleed Driveline infection NauseaClotting disordersStroke

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Roper-Logan-Tierney Model of Living

Photo Credit: www.palliative-ostschweiz.ch

Photo Credit: freepages.history.rootsweb.ancestry.com

Photo Credit: www.persoo.co.uk

Components of the Model

Maintaining a Safe Environment

Use caution with environments that could cause infection

Emergency planning in case of a power outage

General home safety such as safe walkways, removing throw rugs, and handrails in the shower and doorways

Photo credit: www.health-first.org

CommunicationFamily is the most important part of the

interdisciplinary team and must be kept informed and included!

Keep it simple! Instruction should be at the level of the patient; do not use large medical terms!

Facilitate open discussion and therapeutic communication among family members, and to the nursing staff.

“Communication works for those who work at it.” –John Powell

BreathingProvide oxygen as needed Assess lung sounds for fluid retentionMonitor pulse oximetry, if able Assess for shortness of breath secondary

to complications

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Eating and DrinkingNauseaCachexia, malnutrition and

hypoalbuminemia Refer to nutritionist if necessary or

requested Maintain a healthy diet and weight

Photo Credit: www.nutritionyoudesign.com

EliminationGastrointestinal problems are commonAssess bowel sounds and outputReduced gastrointestinal motility

Constipation is common Request stool stofteners

GI bleeding is a common complication which may be seen in stool

Renal function is impaired in 10% of the LVAD population

Washing and DressingShowering only after surgical site has

healedInstruct family on sponge bathing until

surgical site healed Stabalization devices must be worn

under clothing Holsters for batteries are worn outside

the clothing Effect of LVAD on sense of self secondary

to clothing restrictions

Controlling TemperatureAvoid extremes in temperature Instruct proper monitoring of

temperature daily

Photo Credit: www.telegraph.co.uk

MobilizationPatient may not go out alonePatient may not drive Carry extra batteries when leaving home!

Photo Credit: www.lifession.com

Working and PlayingCardiac rehab to strengthen patient after

implantation Encourage patient to improve physical

performanceNo strenuous activities or sportsMay return to work

No heavy lifting or machineryMinimize stress

Clip Art

Expressing Sexuality May resume sexual activity Patients report that resuming sexual

activity is important to quality of life Photo Credit: icoachingzone.com

SleepingSleep disruption due to noise from pump is

common Assess sleep each visit Request sleep aid from doctor if needed

Photo Credit: www.matrac.hu

Death and Dying: Ethical considerations

Patient’s desire to deactivate device may cause ethical dilemma in family or medical staff

Decreased self esteem, depression, anxiety or other complications may lead to desire to deactivate the device

Palliative care team initiated immediately after surgery to implant device for support and guidance

Think-Pair-Share

Photo credit: www.pcworld.com

Scenario One: Mrs. Mendez is a 56 year old patient with chemotherapy induced cardiomyopathy with underlying CHF. She has been given the option to receive an LVAD device as she is not a candidate for transplant. She arrives home after two weeks in the hospital and is admitted by your CHHA. She believes that she can resume her “normal life” of eating foods from her culture, and she continues to smoke. Mrs. Mendez has concerns about her self image, and how people are going to see her when she is in public. Additionally, she is fearsome that her husband will not find her attractive anymore. What education would you provide to this patient?

Scenario Two: Billy is a 12 year old newly implanted LVAD patient. He suffers from a congenital heart disease that has required many surgeries in the past. The doctors have given Billy a grim prognosis if he does not receive a donor heart soon. Billy’s family opts for an LVAD device as a bridge to transplantation. He is sent home three weeks post implantation and, being a typical 12 year old boy, wants to play with his friends, go to school, and resume his activity with the swim team. Billy’s mother has expressed fear over the sterile dressing change, even though she says they “taught her in the hospital.” How would you best care for this family?

Questions??

Conclusion Feel free to contact me with further questions or to discuss a patient:

Victoria C. E. Crawley, RN Oswego County Health

Department 70 Bunner Street, Oswego NY

315-349-3414

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