HeartMate XVE LVAD University of Washington Medical Center VAD Resource Team University of...
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Transcript of HeartMate XVE LVAD University of Washington Medical Center VAD Resource Team University of...
HeartMate XVE LVAD
VAD Resource TeamUniversity of Washington Medical CenterUniversity of Washington Medical Center
VAD Resource Team
Pager/Phone
Cardiac Surgery Shauna Andrus
994-6986 sandrus
5NE/5SE Sheryl Greco 994-4535 sagreco
5NE Kristina Green 598-4500 kegreen
5SE Nicola Kaye 598-6500 kiwi
5SE Janie Shively 598-7369 janie
5NE Eileen Suver 598-4500 esuver
5SE Teddy Villamarin 598-6500 pinoy
Heart Failure
• Heart failure is defined as the inability of the heart to effectively pump oxygenated blood to meet the metabolic demands of the body.
• This devastating condition affects 4.7 million people a year in the United States alone.
• When conventional medical therapies are unsuccessful, cardiac transplantation is an option for treatment and to prolong life.
• Unfortunately, only 2300 patients each year receive heart transplants, because the number of patients awaiting transplants far exceeds the number of organs available.
HeartMate Candidates
• Transplant candidate: •dependent on vasopressor support
OR •incomplete response to continued
vasopressor support
• Approved for ‘Destination Therapy’
• BSA of 1.5 or greater
Pump Percutaneous Tube
Vent Adapter
Weight: 3.74 lbs
Pump volume: 83 ml
Rate: Up to 120
Flow: Up to 10 L/min
Titatanium
Motor with 2 bearings
Vent port
Two tissue valves:
Inflow & Outflow
Inside surface of pump housing
Percutaneous Tube &
Vent Adapter
AVOID:
WATER & POWDER AROUND FILTER
System Controller
“Quick” Connector
System Controller Cables
System Controller
‘Brains’ of system (computer)
Alarms: Audible & Visual
Two cables: connect to power source
‘Quick connect’ to percutaneous lead
System Controller
Change Mode Alarm Reset
System Check Battery Power Check
Power Base Unit (PBU) & System Monitor
Power Base UnitPBU
Internal battery
Battery charger
•AC Fail•Low Batt•Alarm reset
Screen of System Monitor
Pump Rate:
Rate PUMP is beating
Flow:
Cardiac
output
Stroke
volume:
ml/beat
FUNCTION BUTTONS
Auto/Fixed Fixed Rate Fixed Rate
FIXED vs. AUTO MODE
FIXED MODE is a set rate the pump will beat at regardless of other conditions. This rate can be adjusted by using the system monitor, and should always be set at a rate close to the patient’s baseline.
AUTO MODE is responsive to the filling and emptying of the LVAD pump. The pump fills to a fixed volume at a variable rate depending on the patient’s activity and volume status.
NO RELATIONSHIP TO RATE OR RHYTHM OF HEART
Display Module
DISPLAY
•Provides information ONLY
•No button interface
Components:Tethered
1. Quick Connect: percutaneous tube to system controller
2. Power Base Unit Cable: connecting cable from PBU to system controller
3. Twist together connection: system controller to power base unit cable
4. Twist together connection: system controller to power base unit cable
Components: Battery Powered
1. Quick Connect
2. Twist together connect: system controller to battery
3. Twist together connect: system controller to battery
BATTERY
•Requires 2
batteries
•4-6 hours of
power/set
•Worn in holster
Hand Pump: Goes with patient EVERYWHERE
Emergency Power Pack
Battery Clips & Batteries
Changing Power Sources
• Steady tone alarm• Preceded and accompanied by a Yellow Wrench alarm
• May be reset for 2 minutes
RED HEART: HAZARD ALARMS
• May be silenced for 24 hours
• 1 beep per second
YELLOW WRENCH: ADVISORIES
YELLOW WRENCH
1. Power Cable DisconnectMOST COMMON
Routine alarm that sounds when power source (battery or outlet) is changedor only one power source connected
• Check the connections to the power source
YELLOW WRENCH
2. Controller Malfunction2nd MOST COMMON
Caused by a malfunction in the system controller
*Inoperative Controller = ½ wrench*
• Change the system controller
YELLOW WRENCH
3. Power Limit Advisory RARE
Occurs when pump has higher than normal pressure to pump against
• Kinked or occluded vent line Kinked or occluded vent line
replace the extensionreplace the extension• High blood pressure to pump High blood pressure to pump against against
lower blood pressurelower blood pressure
YELLOW WRENCH
4. Rate Control Fault RARE
Occurs when pump is changed to Fixed Mode and the preset rate is:
Less than 50 or
Greater than 120
• Pump defaults to 72 beats per minutePump defaults to 72 beats per minute
correct by attaching the system correct by attaching the system monitor and changing monitor and changing
the backup ratethe backup rate
• Steady tone alarm
• Preceded and accompanied by a yellow wrench alarm
• May be reset for 2 minutes
RED HEART: HAZARD ALARMS
• May be silenced for 24 hours
• 1 beep per second
YELLOW WRENCH: ADVISORIES
RED HEART1. Low Beat Rate or No Op
Low Beat Rate:Pump slows to < 30 bpm
No Op: may be stopped
THIS IS A CRITICAL ALARM AND
CANNOT BE RESET
• Check connectionsmost likely culprit is the percutaneous
tube connection to the system controller
• Check your patient you may need to hand pump
• Check the vent port to insure it is not occluded
• Try changing the power source
• Try changing the system controller
• If pumping does not resume immediately, remove all power sources and start hand pumping
• STAT page the perfusionist on call
• STAT page Surg C Attending or Fellow
• Call for pneumatic console (5NE) with Stroke Volume Limiter (SVL)
• Do NOT restart the pump if it has been off > 5 minutes except with order from Attending or Fellow
RED HEART
2. Low Stroke Volume: < 25 ml3. Low Flow: < 1.5 L/min
• STAT page perfusion
• STAT page Surg C Attending or Fellow
• Consider changing to Fixed Mode to flow
• Assess whether this is a patient or equipment problem
RED HEART CAUSES
• Severe RV failure consider inotropes
• Extreme low blood volume assess for bleeding or fluid loss, replace fluids
• VT, VF or Asystole ACLS protocols EXCEPTION: NO chest compressions (may dislodge outflow conduit)
• LV inflow cannula obstruction requires surgical intervention
XVE System Controller disconnected from the percutaneous tube
FLASHING YELLOW BATTERY RED HEART
YELLOW WRENCHSteady tone
CANNOT BE SILENCED
• Check system controller cable connection
to percutaneous tube
BATTERY ALARMS
• Flashing Yellow Battery
•No tone
• Yellow Battery
•Once-per-second
• Red Battery
•Continuous Audio Tone
FLASHING YELLOW BATTERYNo tone
Battery Module
The battery that controls the alarm lights and tones on the system
controller is low
• This battery controls ONLY the alarm tones and lights, NOT the pump
• Change the battery, then do a controller self-test to clear the alarm
Low Voltage Advisory
Less than 15 min of battery power remain
YELLOW BATTERYOnce-per-second BEEP
• Change to alternate power source
RED BATTERY:Steady tone
• Pump defaults to POWER SAVER MODE: 50 bpm Patient may be symptomatic @ this rate if
used
to faster rate
• Immediately switch to an alternate power source or prepare to hand pump
Low Voltage Alarm
Less than 5 minutes of battery power remains
EMERGENCIES
•VT/VFMonitor BP; Flows; Cardiovert/Defibrillate
•BLOOD FROM EXIT SITESTAT page CT surgeon &/or fellow
•RED HEART Trouble shoot; be prepared to hand pumpSTAT page CT surgeon &/or fellow
IF LVAD MOTOR STOPS
< 5 minutes• Troubleshoot and
get it working again
• Try hand pumping
• Replace system controller
• Try pneumatic console (with SVL)
> 5 minutes• DO NOT attempt
to restart motor
• STAT page perfusionist
• STAT page Surg
C Attending/Fellow
Pneumatic ConsoleCan drive XVE HeartMate if pump failure
Must use STROKE VOLUME LIMITER Pneumatic tubing with
flutter diaphragm
FIXED only available mode No electric connections to provide pump information
Consider transfer to 5SE No alarms on IP console
Three months after implant
University of Washington Medical Center
1997-2006Device Total TX
Waiting/Current
IP HeartMate 19 17
VE HeartMate 22 20
XVE HeartMate 26 23 1
Thoratec PVAD 24 5
Thoratec IVAD 2 1
XVE HeartMate DT/HM II DT 4 1
HM II 7 1 2
TOTAL 102* 66 *4 Combo HeartMate + Thoratec