Assessment of Risks Posed to VAD Patients During Disasters.

Ventricular assist devices (VADs) are an Advanced Life Support for patients with heart failure. These patients are particularly vulnerable in the event of a disaster. A hazard vulnerability analysis (HVA) was conducted to determine areas of susceptibility for these patients. Lack of electrical power, limited access to medications and anticoagulation, dehydration, extreme temperature and weather environments, conditions which predispose to infection, and evacuation transport are all identified circumstances that place these patients at an increased risk for harm and death. Future preparations in disaster planning are needed to address and mitigate these risks. Davis KJ , O'Shea G , Beach M . Assessment of risks posed to VAD patients during disasters. Prehosp Disaster Med. 2017;32(4):457-461.

Monitoring patients with continuous-flow ventricular assist devices outside of the intensive care unit: novel challenges to bedside nursing.

Ventricular assist devices provide therapeutic options for patients with severe heart failure who have exhausted available medical therapies. With restoration of organ perfusion with ventricular assist devices, the heart failure resolves and quality of life and functional status improve. The current generation of continuous-flow devices present novel challenges to the clinical assessment of patients by substantially reducing or nearly eliminating any palpable pulse. Patients therefore generally have inadequate arterial pulsatility for most noninvasive monitoring devices such as pulse oximeters or automated blood pressure cuffs to work accurately. This article describes the function of continuous-flow devices and how this function affects common monitoring options, as well as how to clinically assess recipients of continuous-flow devices to promptly identify those whose condition may be deteriorating or who may be receiving inadequate perfusion.

Variability in infection control measures for the percutaneous lead among programs implanting long-term ventricular assist devices in the United States.

Ventricular assist devices (VADs) are a surgical treatment for heart failure. These devices may be implanted as a bridge to transplant or as destination therapy. After surgical recovery and education regarding device care, patients are discharged home. Meticulous care of the driveline must be taken to prevent infection and trauma of the site throughout the perioperative event and for the duration of support. Currently a standardized protocol for care of the driveline and exit site does not exist. VAD coordinators from across the country discussed the variability in care at different centers in the United States through a series of conference calls. A survey consisting of 16 questions was developed. The survey included questions on preoperative antibiotic recommendations, driveline placement and exit site suturing, frequency of dressing changes, and showering practices. VAD coordinators shared center-specific dressing protocols and any driveline success stories. This survey was sent to 73 centers; 38 centers (52%) responded. The purpose of the survey was to define current practice in order to move toward a standard of practice or protocol based on expert opinion for VAD driveline care and to assess the need for future studies.

Ventricular assist devices: what intensive care unit nurses need to know about postoperative management.

Patients with advanced heart failure have limited treatment options despite advances in medical management. Ventricular assist devices represent a surgical option that offers improved end-organ function, survival, and quality of life. Postoperative nursing management involves the most complicated aspects of care following cardiac surgery as well as issues unique to advanced heart failure and mechanical circulatory support. Despite growing numbers of ventricular assist device implants, literature about the challenging care of patients following ventricular assist device implantation is limited. This article focuses on the physiological basis for postoperative nursing management strategies and the most important complications of which critical care nurses need to be aware.

The Joint Commission's disease-specific care certification for destination therapy ventricular assist devices.

The Centers for Medicare and Medicaid Services announced that all hospitals implanting ventricular assist devices are required to have certification from the The Joint Commission for disease-specific care destination therapy with a ventricular assist device effective March 27, 2009, in order to receive Medicare reimbursement for services rendered to patients who have devices implanted for destination therapy. On February 23, 2007, The Joint Commission released the certification requirements for ventricular assist devices implanted for destination therapy in an 8-page document so that hospitals could prepare to meet the 2009 certification deadline. The Artificial Heart Program of the University of Pittsburgh Medical Center undertook a multidisciplinary project, under the guidance of the nurse coordinator, to prepare the hospital and program for a precertification survey by The Joint Commission for disease-specific destination therapy ventricular assist device certification. The Presbyterian Hospital Artificial Heart Program was awarded The Joint Commission's device-specific certification for destination therapy with ventricular assist devices in June 2008.