LVADS

Question 1

How would you obtain a BP in an LVAD patient?

Answer 1

You will likely not be able to obtain a SBP/DBP. Instead you will obtain a MAP by;

1. using a doppler to auscultate radial artery blood flow
2. inflate the cuff until the artery is occluded and no sound is heard.
3. deflate the cuff until a constant sound returns
4. note the mmHg at hich this sound is heard this is the MAP.

Question 2

How would you determine if the pump is running?

Answer 2

Auscultate over the epigastrium for a continuous mechanical noise

Question 3

What is a suction event?

Answer 3

When the LV collapses around the device inflow line.

Question 4

What are some causes of a suction event?

Answer 4

1. hypovolemia
2. pump speed is too high
3. arrhythmias

Question 5

What are some causes of bleeding in LVAD patients?

Answer 5

1. anticoagulant therapy

2. acquired Von Willebrand’s disease.

Question 6

What percent of patients will have a CVA?

Answer 6

8-10% (Pratt, et al, p. 164)

Question 7

What is a pump specific sign of thrombosis?

Answer 7

Elevated power and floe readings

Question 8

What are some patient specific signs of thrombosis?

Answer 8

1. hemolysis
2. end organ hypoperfusion
3. heart failure
4. thromboembolism

Question 9

What is the most frequent adverse event in LVAD patients?

Answer 9

Bleeding (Pratt, et al, 2014)
1. early bleeding requiring surgery seen in 26% of patients
2.