Common problems with LVADs include driveline infections, hypo/hypervolemia related to underlying CHF, bleeding related to often desired anticoagulants as well of von-willebrand factor deficiencies related to the pump, and electrolyte disorders related to diuretics and kidney function.
Serious problems with LVADs include acute coronary syndrome and dysrhythmias. While the LVAD can maintain the left ventricle function, deficits in right ventricular function can be problematic. Additionally, hypovolemia can lead to a specific problem where the fluid drawn out of the left ventricle is in excess of the flow entering the left ventricular. If the speed of the pump remains the same, the walls of the ventricle will ultimately collapse on themselves. LVADs are designed to deal with situation by decreasing the speed until flow has returned.
Driveline Infections
Dysrhythmia
If LVAD, VT and VF are a big deal because these patients lose filling from the right side. In BiVADs, not a big deal.
Decompensated Vital Signs
Low or High Power
VAD power ranges
Troubleshooting Power Abnormalities
Clot on inflow or outflow-decreased power
Afterload increase-decreased power
Clot on Rotor-increased power
Hypovolemic-decreased power
GI Bleed
Acquired vWF leads to mucosal bleeding. These folks need to go to transplantation ASAP if possible.
Cardiac Arrest
Chest Compressions seem to be safe in Zack and Joe’s Case Report
Additional Information
See this incredible lecture from the Maryland CC Project
