Transition to Next Level of Care

Management of Patient with Ventricular Assist Device

HospitalHome

Transition

Long Term Acute Care Hospitals (LTAC) Acute Rehabilitation (AR) Sub-acute Rehabilitation (SAR) Home

Patients with the following VADs can be safely discharged home:

1. Thoratec PVAD/IVAD on TLC II portable driver

2. Thoratec Heartmate XVE3. Thoratec Heartmate II4. Heartware HVAD* These are the common devices currently

been implanted in Illinois & Indiana

Patient/Caregiver Training with return demonstration and written post tests

Supervised and unsupervised excursions Notification of first responders

EMT Police Ambulance service

Notification of local communityhospital Notification sent to the electric company and request

priority power restoration status Notification of Post Hospital facility or home care

services

General physical condition: Blood pressure Heart rate Temperature Weight

VAD Function Record and document the device specific

parameters

Environment Home

Safety & reliability of electrical system – 3 prong grounded outlets for the power units

Tripping hazards – clutter, loose carpet, pets Potentially dangerous – swimming pools, open water Stairs Location of bedroom, bathroom, shower facilities Emergency communication capabilities – cell phone, land

phone

Environment LTAC/Acute Rehab/SAR

Safety & reliability of electrical system – 3 prong grounded outlets for the power units backed by generator

Tripping/Fall hazards – wires, IV poles, furniture Private room if possible for infection control Room closer to nurses station to listen and

respond to alarm conditions

Exit Site Tissue incorporation Drainage Surrounding tissue for erythema, swelling, tenderness

VAD Pocket Fluid over VAD pocket Skin discoloration or cellulitis Pain Blistering

Midline Incision/Scar Swelling Blistering Open blister/drainage Cellulitis

Patient comfort with equipment management Safety issues Progression with rehab (PT/OT/Speech) Glucose monitoring I/O’s Pressure Ulcers

VAD patients require close and regular monitoring of labs CBC CMP Magnesium PT/INR BNP

VAD patient as an immunosupressed

patient !!!!

Strict hand washing before and after caring for patient.

Follow infection control policy and guidelines of your facility or agency.

Exit site stabilization – abdominal binder

Do not cohort patient with actively infected patient

Center specific protocol for dressing changes including protective equipment

Hand washing! Minimize traffic in the room during

dressing changes Sterile/Aseptic dressing changes Recognize signs & symptoms of

infection and report to the VAD team/coordinator immediately!

Supplies Please provide one week of supplies for

patient to go home till outpatient supplies are arranged

Please set up or provide information on ordering wound care supplies prior to discharged from your services

Active involvement of social services

Daily Aspirin for anticoagulation for all devices Coumadin is anticoagulation for all devices except

Heart Mate XVE Heart Failure medications Miscellaneous medications

Key to successful patient outcomes!! Communicate regularly with the VAD

Team on the following: Abnormal labs Coumadin dosing Any change in clinical status Any signs and/or symptoms of infection DEVICE ALARMS

All VAD Centers have clinicians providing 24 hour

clinical support

Questions????