A Guide to Mechanical Circulatory Support: A Primer for Ventricular Assist Device (VAD) Clinicians

Description

This unique book details a multidisciplinary approach for providers caring for the Mechanical Circulatory Support (MCS) patient. Authors discuss the history of MCS, patient selection, surgical and post-operative care, mobility and nutritional issues for this subgroup of patients, along with outpatient management.  They are expert clinicians in the field of MCS and Extracorporeal Membrane Oxygenation (ECMO), who provide direct patient care, conduct research, publish and maintain current leadership positions within the International Society of Heart and Lung Transplant and International Consortium of Circulatory Assist Clinicians.Non-clinical issues including Regulatory, Reimbursement, Administration, Program Development and links to Professional Organizations supporting MCS Clinicians are presented in the book that will be of great value to Nurses first, but also to Advanced Practice Providers (NP/PA), Dieticians, Physical Therapists and Administrators. Foreword Evolution of Pump Design: Disruptive Changes in the Course of AHF Care Program Structure: Impacted by Research and Regulations Team Composition and Patient Management: From Organic to Intentional VAD Clinician Professional Development Acknowledgments Contents Mechanical Circulatory Support: Evolution and History History of Mechanical Circulatory Support Overcoming Some of the Hurdles History of the VAD Coordinator Role The Future References Pump Design and Mechanics Pump Design and Mechanics Pulsatile VAD Designs Cannulas and VAD Placements Handpump Pulsatile Waveforms Non-Pulsatile VAD Designs HQ Curves Suction Events Artificial Pulse Non-Pulsatile Waveforms Common Components for Pulsatile and Non-Pulsatile Devices Percutaneous Lines Controllers Power Sources Battery Chargers Monitors Blood Contacting Surfaces/Biomaterials FDA Monitoring Future VAD Designs References Mechanical Circulatory Support Indications and Patient Selection Introduction Indication for MCS Intentions for Treatment Reimbursement Indications Contraindication for MCS Patient Selection References Patient Optimization Prior to MCS Introduction STS INTMERMACS® Score Preoperative Concerns and Comorbidities Malnutrition Anemia Hematologic Disorders Diabetes Mellitus (DM) Peptic Ulcer Disease Hepatitis Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) Arrhythmias/ICD Shocks Sleep Apnea Chronic Obstructive Pulmonary Disease (COPD) Coronary Artery Disease (CAD) Peripheral Vascular Disease (PVD) Renal Dysfunction Obesity Depression and Anxiety Psychosocial Readiness for LVAD Implant Cognitive Evaluation Psychiatric Illness Alcohol, Tobacco, and Substance Abuse Adherence to Medical Therapies Family/Caregiver Support Financial Support Increasing Physical Conditioning Pre and Post MCS Hemodynamic Optimization Before MCS Implant Infection Control Conclusion References Surgical Insertion of a Ventricular Assist Device Preoperatively Operative Techniques Procedure Intra-op TEE Anesthesia Pearls Intraoperative Management During Procedure Postoperative Management of the VAD Patient Immediate Postoperative Care Return to the Intensive Care Unit Necessity of the Implantable Cardio-Defibrillator Inotrope Use Chest Tube Output Nitric Oxide Use Ventilator Management Echocardiography Guidance with Speed Optimization Management of Surgical Lines Antiplatelet and Anticoagulation Use in LVAD Heparin Warfarin Aspirin Generalities Due to Pump-Specific and Program-Specific Guidelines Timing of Extubation Pulmonary Hygiene and Lung Volume Expansion Spirometry Nutrition in a VAD Patient Labs and Imaging of the Hospitalized VAD Patient Laboratory Checks Imaging Studies and Procedures Frequency Importance of Right Ventricular Function Following Implantation Right Ventricular Strain Early Right Ventricular Failure Consideration of Right Ventricular Assist Device Use of Phosphodiesterase-5 Inhibitors Pain Mitigation and Bowel Regimen Consideration of Blood Products Activity Post VAD Sternal Precautions Multidisciplinary Team Engagement Engagement of Inpatient/Outpatient Rehab Options Patient and Caregiver Education Preparation How to Carry the LVAD How to Shower with the LVAD Alarms Excursions (Where Applicable) Calling the LVAD Team Inpatient Driveline Dressing Management Equipment and Dressing Supply Distribution Discharge Preparation Rehabilitation Center Needs Local Laboratory Community Contacts References Ventricular Assist Device Complications Introduction Bleeding Gastrointestinal Bleeding Epistaxis Hemorrhagic Stroke Right Ventricular Failure Arrhythmia Infection for Length, Consider Removing this Completely Stroke Pump Thrombosis Causes Diagnosis Treatment Prevention Pump Obstruction Short-to-Shield Conclusion References Infectious Concerns and Prevention for Patients with Ventricular Assist Devices Infection Definitions Preoperative and Intraoperative Planning Driveline Exit Site Infection Background and Prevalence DLES Pathogens DLES Infection Staging DLES Diagnosis and Treatment DLES Prevention Techniques DLES Care Pump Pocket Infection Pump Pocket Infection Treatment Pump/Cannula Infection Approach to the Patient with a Suspected VAD Infection Imaging Bacteremia Mediastinitis/Infective Endocarditis Stroke Transplant Outcomes References Anticoagulation for Ventricular Assist Devices Anticoagulation and Antiplatelet Agents Perioperative Management of Anticoagulation Long-Term Anticoagulation and Antiplatelet Therapies Monitoring INR Modification of Anticoagulation for Adverse Events Reversal of Anticoagulation Management of Anticoagulation in Patients Who Refuse Blood Products Anticoagulation in Pediatric Patients with LVADs Conclusion References Exercise and Physical Therapy with Ventricular Assist Devices Cardiac Rehabilitation in Literature Clinical Assessment Factors That Can Limit Functional Exercise Training Monitoring Exercise Training Implementation of Exercise Training Acute Hospitalization Early Mobilization Sternal Complications and Precautions Sub-acute Phase UL Strength Training Long-Term Phase Contraindications and Precautions to Exercise Infection Control Multidisciplinary Team (MDT) Recommendations for Research References Nutrition for the Advanced Heart Failure and VAD Patient Importance of Nutrition and the Role of the Registered Dietitian Nutritionist in Patient Care Malnutrition in Heart Failure and the Nutritional Implications of Cardiac Cachexia Nutrition Screening and Assessment Parameters Nutritional and Surgical Interventions Nutrition Support for Perioperative and Postoperative Critical Care Postoperative Education, Discharge Process, and Role of Interdisciplinary Care Team Outpatient Follow-Up Hospital Readmissions and Other Barriers to Nutrition Progress References Outpatient Management for the VAD Patient Upon Discharge Clinic Visits Routine Parameters to Be Monitored in Clinic Labwork Monitoring Pump Speed Optimization Telemonitoring Types of Remote Monitoring Multidisciplinary Team Involvement Leaving the Home and Traveling Conclusion References Regulatory Agencies Impacting Mechanical Circulatory Support Programs Introduction Industry and Clinical Investigation Oversight Registry Participation Centers for Medicare and Medicaid Services Program Certification Non-U.S. Programs Summary References Reimbursement in Ventricular Assist Device Implant and Care Defining Reimbursement and Terminology Demystifying Insurance Payers: Government vs. Private Prior Authorizations and Medical Necessity Patient Impact Program Impact Coding Outpatient Supplies Program Financial Success Additional Resources Ventricular Assist Devices for the Pediatric Population Introduction General Pediatric Indications and Contraindications Pre-implant Considerations Single Ventricle VAD Support Paracorporeal Pumps in Pediatric VAD Support Nutrition Unique Psychosocial Needs for the Pediatric VAD Patient: Top  Five Differences and Considerations Rehabilitation Discharge and Community Reintegration Destination Therapy (DT) References Temporary Mechanical Circulatory Support Introduction Intra-Aortic Balloon Pump (IABP) Configuration and Mechanism of Action Indications and Contraindications Complications Impella (Abiomed) Engineering and Function Indications/Contraindications Complications Indications for Surgical Impella/Escalation Weaning Left Atrial to Femoral Arterial Bypass Configuration Indications and Contraindications Complications Right Atrial to Pulmonary Artery Bypass Configuration Indications/Contraindications Complications Extracorporeal Membrane Oxygenation (ECMO) Configuration Indications/Contraindications Complications Conclusion References Administrative Aspects of the Ventricular Assist Device Program Development Upfront Costs Leadership and Team Structure Cost Analysis Preparing for Implantation Programmatic Guidelines Certification Equipment Growth and Evolution Continued Coverage Outreach Conclusion References Psychosocial and Palliative Aspects of VAD Care Psychosocial Risk at Selection Stress, Coping, and Support After VAD Implant Palliative Care Consultation Before LVAD Implantation End of Life with LVAD References Professional Organizations in the Mechanical Circulatory Support Community: An Opportunity to Network Organizing Your Search Technology-Specific Search Nursing Community of Practice-Specific Search Interdisciplinary-Specific Search Additional Benefit to Professional Organizations: Networking Summary References Clinical Research and Applications to Mechanical Circulatory Support Basics Forming the Research Idea Principal Investigator Protocol Types of Trials Randomization Regulatory Data Collection Quantitative Qualitative Data Analysis The Report Authorship Abstract Methods Results Implementation of Research Grant Applications Project Budget Timely Completion of Data Points Monitoring, Auditing, Inspection Dissemination of Research Oral Presentation of the Report Poster Presentation of the Report Manuscript Publication of the Research Conclusion References Mechanical Circulatory Support in the Era of COVID-19 Introduction COVID-19 and Cardiac Disease MCS and COVID Treatment for VAD Patients with COVID-19 Implantation and Follow-Up of Durable MCS in the COVID Era References