HeartMate II Left Ventricular Assist Device (LVAD) University of Washington Medical Center.
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Transcript of HeartMate II Left Ventricular Assist Device (LVAD) University of Washington Medical Center.
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HeartMate II Left Ventricular Assist Device (LVAD)
University of Washington Medical Center
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BACKGROUND• Ventricular assist devices (VADs) are a proven therapy
as bridge-to-cardiac transplantation in Class IIIB and Class IV heart failure patients
• The dramatic increase in the use of VADs has been unavoidable for those patients suffering end-stage heart failure due to the consistent shortage of donor organs
• As mean support duration for VADs increases, more VAD patients will be living in the community
• HeartMate LVAD is approved as Destination Therapy (DT)
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HM II CANDIDATES
FDA Approved 4.21.08• Bridge-to-Transplant (BTT)
FDA Approved 1.20.10• Destination Therapy (DT)
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Cored into LV
Outflow to aorta
Percutaneous tube
System Controller
Batteries
HM II
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Anatomic Placement
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FUNCTION & CAPABILITY
• Axial (continuous) flow: ?NO PULSE/ ?BP• One moving part: Rotor• Small
400 gm 125 cc 60% smaller than HM I (XVE)
• Quiet• Flows: 3 – 10 lpm• Anticoagulation required
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ADVANTAGES• Size: Potential BSA of .8 m2
• Only one moving part
• Blood lubricated bearings
• Designed for long term support
• Lower infection rates (smaller perc tube)
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Pump Housing
Rotor
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PUMP ROTOR and STATORS
Inflow Stator
Inflow Bearings
RotorOutflow Bearins
Outflw Stator
BLOOD FLOW
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Controller + Back-up Controller
SYSTEM CONTROLLER
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FACE OF SYSTEM CONTROLLER
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POWER MODULE
Supplies main power to LVAD
Provides 30 minutes of backup power
Repeats alarms generated by the System Controller
Serves as the electrical interface between the System Controller and the Display Module
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BATTERY CHARGER
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BATTERIES
• 14v Li-Ion
• 6 – 10 hours of support *Patients report up to 15 hrs of battery power
• Up to 4 hour recharge for fully discharged battery
• 3 years or 360 charges
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DISPLAY MODULE
Fixed Speed 9600 PI 5.5 Flow 4.5 Power 8.2
Fixed Speed 9600 PI 5.5 LOW FLOW for < 1 min
•Pump ModeFixedPower Saver
•Pump Speed (rpm)•Pulse Index•Estimated Flow (lpm)
Too low “---”Too high “+++”
•Power (watts)
•Alarm Conditions Highest priority displayed
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EMERGENCY POWER PACK (EPP)
• Single use battery pack in a plastic carrying case with a shoulder strap
• Provides battery power in the event of extended power outage
• Approximately 12 hours of support
• Must be replaced if used for a period exceeding three hours
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BATTERY ALARMSADVISORY ALARMSHAZARD ALARM
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BATTERY ALARMS BATTERY < 15 minutes of power
BEEP Q SEC BATTERY < 5 minutes of power
STEADY TONEDefaults to ‘Power Saver Mode’ Pump defaults to Fixed Rate Mode of 8000 rpm, or fixed
speed setpoint if lower System will return to set speed once adequate power is
restored
ACTION • Replace batteries
or switch to alternate power source
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SYSTEM DRIVER CELL LOW VOLTAGE
SYSTEM CONTROLLER CELL LOW VOLTAGE Yellow cell symbol Beep every 4 seconds
ACTION • Replace cell battery and perform
System Controller self test
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POWER CABLE DISCONNECTED
and FLASHING
POWER CABLE DISCONNECTED Flashing green power symbol & battery power
bars Beep every second
ACTION• Check cable connections to power source• Check power leads for damage, replace if necessary
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LOW FLOW; NO OPERATION or INCORRECT OPERATIONLOW FLOW < 2.5 lpm Pump not operating or not operating correctly Decreased preload (right heart failure,
tamponade, hypovolemia, bleeding, etc) Obstruction of pump inflow or outflow Systemic hypertensionACTION• Assess patient• Monitor
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DRIVELINE DISCONNECTED FROM CONTROLLER
• Check connections
ACTION• Reconnect driveline to controller
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STEADY TONE andNO SYMBOL• NO POWER TO PUMP
ACTION• Check system driver connections to pump• Check system driver power connections to
power source• If persist, seek additional help immediately
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CPR SHOULD NOT BE PERFORMED ON HEARTMATE LVAD
PATIENTSUNLESS DIRECTED
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VT or VF
• STABLE– Patient may “feel funny” “light headed” or “different”– Pump speeds and flows are normal, low normal, or very
low– Consider cardioversion after consultation with Mechanical
Assist Device Coordinator
• UNSTABLE– Patient unresponsive– Treat as unstable VT/VF
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LVAD PATIENT TRANSPORT
• Transport to UWMC• Spare batteries, PBU and the display module
should be brought to the hospital with the patient
• PBU weighs 29 pounds without batteries• All modes of emergency transportation are
acceptable• Aviation electronics will NOT interfere with
LVAD and visa versa
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SHAUNA ANDRUS, RNAMY UNGERLEIDER, RN
JANIE SHIVELY, RN
Mechanical Circulatory Support Coordinator
UNIVERSITY OF WASHINGTON MEDICAL CENTER24/7 CONTACT
UW PAGING OPERATOR206.598.6190
Ask for VAD Coordinator On Call
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NAHUSH MOKADAM, MD
Assoc. Director Cardiac Transplant and
Mechanical Assist Device ProgramsUNIVERSITY OF WASHINGTON MEDICAL CENTER
office 206.543.3093
Paging operator
206.598.6190
MEDCON
800.326.5300