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biVAD

January 2015

1. Can I do external CPR? No. 2. If not, is there a “hand pump” or external device to use? Yes,findtheblueorredhandbulbs.3. Ifthedeviceslowsdown(lowflowstate),whatalarmswillgooff? Lowflowalarms:Lossoffillalarmwilloccur4. How can I speed up the rate of the device? GivevolumeofIVfluids.5. Do I need to heparinize the patient if it slows down? Onlyifitstops.PatientwillbeanticoagulatedonCoumadin. Onlyheparinizeifthepumpstops.6. Canthepatientbedefibrillatedwhileconnectedtothedevice? Yes. Nothingneedstobedisconnected.Patientshouldbeplaced onbatterypowerBEFOREdefibrillation.7. Ifthepatientcanbedefibrillated,isthereanythingIhaveto disconnectbeforedefibrillating? No. Ifthedefibrillationisunsuccessful,disconnectpumpand continuetodefibrillate.8. Does the patient have a pulse with this device? Yes.9. Whatareacceptablevitalsignparameters? Normalbloodpressureparameters.10. Can this patient be externally paced? UsuallyinBiVADconfiguration,ifyestheECGnotimportanttotreat. Becausebothsidesoftheheartaresupported,thereislittleneed topaceregardlessoftherhythmseenonECG.

Thoratec PVAD™ w/TLC II Driver

IVAD is implanted inside the abd cavity and is attached to the same TLC II driver on the outside.Adapted from Sweet, L. and Wolfe, Jr., A. Mechanical Circulatory Devices in Transport in ASTNA: Patient Transport Principles and Practice, 4th ed., Mosby, 2010 in press.

l Thesepatientshavebiventricularsupportthrough2pumps:rightandleft.

l EKGwillNOTcorrelatewiththepatient’spulse.

l Patientmaybeinanyarrhythmia,butbecausetheyhavebiventricularsupport—DONOTTREATarrhythmias.OnlyRVADorLVADpatientsshouldbetreatedforarrhythmias.

l Bringallextrabatteries&electricaladaptoralongduringtransport.Thissystemiselectricallydriven.

l ThepumpsaredrivenbyacompressorcalledtheTLCIIdriver.ThepneumatichosesandcablesplugintothetopoftheTLCIIdriver.

l IftheDriverlosespower,malfunctions,orstops,usethehandpump(s).(handpumpinstructionsonbackofthispage)

l Continuehandpumpingandthen,assoonaspossible,replacetheTLCIIDriverwiththebackupDriver.

l BackupDriveraccompaniesthepatientatalltimes.(Driverreplacementinstructionsonbackofthispage)

l WARNING:Ifthepumphasstoppedandbloodisstagnantinthedeviceformorethanafewminutes(dependingonthecoagulationstatusofthepatient),thereisariskofstrokeorthromboembolism.BEFOREthedeviceisrestartedorhandpumpingisinitiated,contacttheimplantingcenterforanticoagulationdirection.

AC Power adapter – plug into yellow port on driver

Battery Charger

Batteries loaded into battery slots on TLC-II Driver

TCL-II Driver

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PVAD/IVADType of Device: pulsatile

IVAD is implanted inside the abd cavity and is attached to the same TLC II driver on the outside.

Questions:

1. CPR:NO2. Handpump:yescalledhandbulbs3. lowflowalarms:LossofFillalarm4. speedupdevice:fluids5. heparin:onlyifitstops.Patienthastobeon

Coumadin6. defib:yes7. disconnectfordefib:no8. pulse:yes9. Vitalsigns:NormalBPparameters10. externallypace:UsuallyinBiVADconfiguration

ifyestheECGnotimportanttotreat

What is an LVAD?Left Ventricular Assist Devices are pumps surgically attached to patients’ hearts to pump blood for the ventricle. There are three basic parts to all VAD systems. The pump, a computer with lamps and alarms, and a power source.

WhydopatientsgetVADs?Patient who have been treated for heart failure but in spite of optimal care continue to suffer from life limiting heart failure. Patients may be on the heart transplant list but the transplant team is worried the patient may die before a suitable donor is found, bridge to transplant. Pts who are not candidates for transplant but suffer from end stage heart failure may also be implanted as destination therapy.

How do VADs work?Most vads implanted nationally create continuous flow. Blood comes from patients own ventricle into the pump then a turbine like spinning fan pushes the blood out into the aorta then the body. A cable connects the pump inside with the computer/controller and batteries outside the body. The pump needs a constant power supply.

Do’s1.PagetheOnCallPerfusionist.CalltheTowerORat3316toaskforthebeepernumber.

2.Givewhatevermedicationsyouwant.(nomedicationcontraindication)

3.Defibrillateifindicated4.Handpumponlyifthedevisehasstoppedpumping,leftfasterthanright.

Don’ts1.NOCHESTCOMPRESSIONS.2.NOMRI.3.Don’tpaniciftheECGisatonerate.TheLVADrateisatanother,andtheRVADrateisathird.

biVAD

January 2015

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Hand Pumping Instructions

Switching to Backup TLC-II Driver

January 2015

Step 1:Obtainhandpump(s)fromcarryingcase.Note:One(1)handpumpisneededforeachVAD.

Step 3:Connectthehandpump(s)tothepneumaticlead(s).

Step 4:Squeezehandpump(s)oncepersecond.Useyourfootifnecessary.Note:For2VADs(BiVADs),squeezeeachhandpumpatthesamerate.NeverhandpumptherightVAD(RVAD)fasterthantheleftVAD(LVAD),asthismaycausepulmonaryedema.

Step 2:Depressmetalclip(s)todisconnectthepneumaticlead(s)fromtheTLCIIDriver.

Step 1:Insertafully-chargedbattery(storedincarryingcase)intoeachbatteryslotofbackupTLC-IIdriver.

Step 2:Turnonkeyswitch

Step 3:Depressmetalclip(s)toremovewhiteoccluderfrompneumaticport(s):

lLVADportisRED.

lRVADportisBLUE.

lNote:forBiVADS,switchLVADfirst.DoNOTremoveoccludercapsfrombothportsatthesametime(orfromunusedportduringsingleVADsupport),orsystemwilldepressurize.

Step 4:Disconnectpneumaticlead(s)fromprimaryDriver(orhandpump)andconnecttobackupDriver.

Step 5:Disconnectelectriclead(s)fromprimaryDriverandconnecttobackupDriver.

Step 6:PlaceDriverinAUTOmode,ifnecessary.Note:BackupDriversarepreprogrammedwithapatient’suniquesettings.

Step 7:Verifyfullsignal(s)is/areejectingcompletely.

Step 8:Removekeyandplaceincarryingcasepocket.

Step 9:Connecttoexternalpower,ifavailablebyusingtheACpoweradaptercord.

All modes of emergency transport are acceptable for VAD patients. Aviation electronics will NOT interfere with VAD operation (and vice versa).

Air Transport Consideration: In rotor wing and fixed wing aircraft flying at heights lower than 10,000 feet-when using the hand pump for external CPR, you must re-purge the bulb every 2000

feet in ascent and 1000 feet in descent. This will assure you have consistent cardiac output.