Ventricular Assist Device, Home Care

It 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 to live.

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

  • Are awaiting a heart transplant. You must live within 2 hours of the transplant center.

PARTS OF A VENTRICULAR ASSIST DEVICE

The parts of a VAD are:

  • Inflow tube-brings oxygenated blood from the left ventricle to the pump.

  • Outflow tube-brings blood from the pump to the aorta. The aorta is a large artery that takes oxygenated blood to your body.

  • Pump. This is implanted into the body.

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

  • System controller. This consists of batteries and the electronics which control the device.

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

VENTRICULAR ASSIST DEVICE DAILY CARE

  • Inspect the VAD tubing exit site once a day or as told by your caregiver. Let your caregiver know right away if any of the following occur at the VAD tubing exit site.

  • Redness.

  • Swelling.

  • Any type of fluid drainage.

  • Increased warmth.

  • Bad odor.

  • Each day, record the following on your VAD flow sheet. This is a sheet for you to record information regarding your health and how well the VAD is working.

  • Temperature.

  • Blood pressure.

  • Weight.

  • VAD speed (rpm).

  • Pulsatility index (PI).

  • Power.

  • Flow (L/min).

BANDAGE (DRESSING) CHANGES

Change your VAD dressing as directed by your caregiver. You will be taught how to change the dressing at the hospital before you go home. The VAD dressing change is a two step process.

  • The first step of the dressing change is a non-sterile technique. Follow the steps below to take off the old VAD dressing:

  1. Wear a mask.

  2. Wash your hands.

  3. Put on non-sterile gloves.

  4. Remove the old dressing.

  5. Remove the gloves. Wash your hands again.

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

  • To replace the VAD dressing, you must use a germ free (sterile) technique. Follow the steps below to replace the VAD dressing.

  1. Continue wearing the mask.

  2. Set up the supplies using sterile technique.

  3. Put on sterile gloves.

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

  5. Gently dry the site with dry sterile gauze.

  6. Apply drain sponges (a gauze dressing that has a slit in it) to the VAD tubing exit site. Cover with a 4 inx 4 in (10 cm x 10 cm) gauze pad.

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

  • To keep the VAD tubing from moving, use a securement device as directed by your caregiver. The VAD tubing must be kept secure to help prevent:

  • Damage to the VAD tubing.

  • Site irritation at the VAD tubing exit site.

  • Infection.

VENTRICULAR ASSIST DEVICE ACTIVITIES:

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

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

  • Do not take baths or go swimming with an implanted VAD.

  • 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 with an implanted VAD.

  • Do not jump up and down excessively.

  • Do not lift more than 10 lbs (22 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 as long as you have your VAD. When leaving home, make sure you take:

  • A spare system controller.

  • Extra VAD batteries.

TRAVELING

  • Notify your VAD coordinator before you travel and let them know:

  • Your travel dates.

  • How long you will be gone.

  • Know where the nearest VAD center is when you travel.

  • Notify that center of the dates you will be in the area.

  • Have names and telephone numbers of who to contact in case of emergency.

  • 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 device. 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 machine. Security may need to inspect the outside parts of the VAD.

OTHER IMPORTANT VAD TIPS

  • Become familiar with your VAD. Be sure you:

  • Know all parts of the VAD and what they are for.

  • Understand the VAD alarm functions.

  • Are comfortable doing sterile dressing changes.

  • Know what to do in case of an emergency.

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

  • 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.

  • Avoid being active in very hot or cold weather.

  • Talk to your caregiver about drinking alcohol.

  • Be careful around computers and televisions due to static electricity. Avoid touching televisions or computer screens. Use an anti-static spray as needed.

  • Do not vacuum.

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

LAB WORK

  • While you have VAD, you will be on blood thinner (anticoagulant) medication. You will need blood work to monitor:

  • How "thin" your blood is.

  • Other lab values that are important to your health.

CALL YOUR HEART FAILURE DOCTOR OR VAD COORDINATOR IF:

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

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

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

  • You have any type of chest pain or pain at the VAD tube exit site.

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

  • You have any VAD concerns.

SEEK IMMEDIATE MEDICAL CARE IF:

  • If the pump is not running properly, call your local emergency service (911 in the U.S.) and VAD coordinator IMMEDIATELY for the following:

  • Loss of power to the pump.

  • Any unexplained or unusual alarms.

  • Broken wires.

  • Damage to the pump motor or system controller.

  • Any health changes affecting your heart.

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

  • An unexplained temperature above 102° F (38.9° C) develops.

  • You have shortness of breath (SOB) or difficulty breathing.

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

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