Ventricular Assist Device, Home Care

ExitCare ImageIt is important to follow home care instructions to care for your ventricular assist device (VAD). Going home (destination therapy) with a VAD is becoming more common for people who:

  • Are not candidates for heart transplantation and need a VAD.

  • Have heart failure and need time to let the heart rest.

  • Are awaiting a heart transplant.

PARTS OF A VAD

A VAD consists of the following parts:

  • Inflow tube. This tube carries oxygenated blood from the left ventricle to the VAD pump.

  • Outflow tube. This tube carries blood from the VAD pump to the aorta. The aorta is a large artery that carries oxygenated blood from your heart to the rest of your body.

  • Pump. The VAD pump is implanted inside the body.

  • Drive line (percutaneous lead). This tube connects the pump to the system controller.

  • System controller. The controller consists of batteries and electronics which control the VAD.

The VAD is powered by either batteries or an electrical wall outlet.

INSPECTION OF THE VAD

  • Inspect the VAD tubing exit site once a day or as told by your caregiver. If there is redness, swelling, drainage, warmth, or a foul odor at the VAD tubing exit site, call your caregiver or VAD coordinator.

  • Record the following on your VAD flow sheet daily.

  • Your temperature.

  • Your blood pressure.

  • Your weight.

  • The VAD speed (rpm).

  • The VAD pulsatility index (PI).

  • The VAD power.

  • The VAD flow (L/min).

VAD BANDAGE CHANGES

Change your VAD bandage (dressing) as directed by your caregiver. You will be taught how to change the dressing at the hospital before you go home. A VAD dressing change requires the removal of the current dressing, the replacement of a dressing, and the securement of the VAD tubing.

  • Remove the current dressing. Use an unsterile (clean) technique to remove the current dressing. Follow the steps below to remove the current VAD dressing:

  1. Wear a mask.

  2. Wash your hands.

  3. Put on unsterile gloves.

  4. Remove the current dressing.

  5. Remove your gloves. Wash your hands again.

  6. Do not touch the tubing at the VAD tubing exit site after the dressing has been taken off.

  • Replace the VAD dressing. Use a germfree (sterile) technique. Follow the steps below to replace the VAD dressing.

  1. Continue wearing the mask.

  2. Set out the supplies using sterile technique.

  3. Put on sterile gloves.

  4. Clean the VAD exit site using the product your caregiver has instructed you to use.

  5. Gently dry the exit site with dry sterile gauze.

  6. Apply a slit gauze dressing (drain sponge) to the VAD tubing exit site. Cover with a 4 inch square (10 cm square) gauze pad.

  7. Secure the dressing with tape or specified product as directed by your caregiver.

  • Secure the VAD tubing as directed by your caregiver. The VAD tubing should be secured to prevent:

  • Damage to the VAD tubing.

  • Irritation at the VAD tubing exit site.

  • Infection.

LIVING WITH A VAD

  • Become familiar with your VAD. Be sure you:

  • Know all parts and functions of the VAD.

  • Understand the VAD alarm functions.

  • Are comfortable doing sterile dressing changes.

  • Know what to do in case of an emergency.

  • When leaving home, make sure you take:

  • A spare system controller.

  • Extra VAD batteries.

  • Do not smoke. Avoid places where you will be exposed to secondhand smoke. Smoking and secondhand smoke cause your arteries to tighten. This decreases blood flow and will make your pump work harder.

  • Eat healthy foods. Eat small, frequent meals.

  • Ask your caregiver about the use of vitamins and mineral supplements.

  • Talk to your caregiver about drinking alcohol.

  • Avoid being active in very hot or cold weather.

  • Balance activity with periods of rest.

  • Resume sexual activity as advised by your caregiver.

  • Avoid touching televisions or computer screens. This is a safety precaution to avoid static electrical shocks. Use an anti-static spray as needed.

  • Do not vacuum.

  • Schedule and attend all follow-up appointments as directed by your caregiver. It is important to keep all your appointments.

  • Schedule and attend all follow-up laboratory appointments as directed by your caregiver. While taking anticoagulants, you will need to have frequent blood samples to measure the clotting time of your blood.

  • Participate in cardiac rehabilitation as directed by your caregiver.

  • Obtain ongoing support.

  • If you require ambulance or emergency services, a trained caregiver should stay with you at all times.

  • Chest compressions should not be performed when you have a VAD.

RESTRICTIONS WITH A VAD

It is important to follow your caregiver's instructions on what you can and cannot do regarding activities. Guidelines for restricted activities include:

  • Do not expose the VAD to water. This can cause VAD pump failure.

  • Do not take baths or go swimming.

  • You may take showers as directed by your caregiver. You must use a shower bag to cover the VAD equipment. Your caregiver will show you how to cover the VAD parts. Do not get the connection between the percutaneous lead and the system controller wet.

  • Do not play contact or physically challenging sports.

  • Do not jump up and down excessively.

  • Do not lift more than 10 lb (4.5 kg) for the first 6 weeks or as directed by your caregiver.

  • Do not sleep on your stomach.

  • Do not drive or operate heavy machinery.

TRAVELING WITH A VAD

  • Notify your VAD coordinator before you travel and let him or her know:

  • Your travel dates.

  • Your length of travel.

  • Identify the closest VAD centers to your travel destinations.

  • Notify those centers of the dates you will be in the area.

  • Carry names and telephone numbers of emergency contacts.

  • Get permission from your caregiver before you travel by air or train. You will need to notify airline or train security that you have a VAD. To pass through security:

  • You will need a letter from your caregiver explaining your medical condition and VAD equipment.

  • Do not go through the X-ray equipment. Security may need to inspect the external VAD parts.

CALL YOUR HEART FAILURE SPECIALIST OR VAD COORDINATOR IF:

  • The VAD flow rate, PI, and power are not at rates as instructed by your caregiver.

  • You have swelling in your ankles or feet. This may be a sign of water retention.

  • You gain or 3 pounds (1.36 kg) or more in 1 day. Or, follow your caregiver's advice regarding weight gain.

  • You have any type of chest pain.

  • You have redness, pain, warmth, foul odor, or drainage at the VAD tube exit site.

  • You notice changes in how the VAD feels or works.

  • You have any VAD concerns.

  • You have persistent bleeding.

  • You have an increase in bruising.

  • You have abdominal pain.

  • You have nausea or vomiting.

  • A fever.

CALL YOUR LOCAL EMERGENCY SERVICE AND VAD COORDINATOR

Call your local emergency service (911 in U.S.) and VAD coordinator immediately if the pump is not functioning properly. Pump malfunctioning includes:

  • Loss of power to the pump.

  • Any unexplained or unusual alarms.

  • Broken wires.

  • Damage to the pump motor or system controller.

  • Red heart alarm. This is an alarm that signals VAD pump failure.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have shortness of breath or difficulty breathing.

  • You have chest pain, or pain that spreads to your arm, neck, jaw, back, or abdomen.

  • You have blood in your sputum, vomit, or stool.