•
Don’t allow the percutaneous lead to catch or snag on anything that will pull on
or move the lead.
•
Check the percutaneous lead daily for signs of damage (cuts, holes, tears).
Controlling Infection
Infection among implantable LVAD patients is common, especially in patients with
multi-system organ failure who require prolonged stays in the ICU. Infection rates
can be minimized, however, by applying the following approaches to patient man-
agement:
·
Strict adherence to aseptic technique during exit site care (as outlined above).
·
Remove all intravascular lines as soon as practical to reduce the risk of systemic
infection.
·
Administer antibiotic prophylaxis in the post-operative period and for suspect-
ed or confirmed infections and antibiotics for surgical drainage (as indicated)
in patients with evidence of pump pocket infection.
·
Adhere to strict blood glucose control.
·
Initiate nutritional support to correct nutritional deficits.
Note
: Refer to Thoratec's
Infection Control Guidelines
(document number 102512)
for detailed information about approaches to successful infection control used by
experienced LVAD implant centers with low rates of infection.
Measuring Blood Pressure
Automatic blood pressure monitors may not be accurate. Manual ausculation with a
Doppler is recommended. In circumstances where the flow is pulseless, invasive
blood pressure monitoring (arterial line) may be required.
Anticoagulation
HeartMate II patients are placed on Warfarin® to
maintain an INR of 2 - 3
and
antiplatelet therapy consisting of aspirin 81mg daily combined with Dipyridamole
75mg TID.
Activities of Daily Living
Sleeping
HeartMate II patients must be attached to the PBU while sleeping or anticipating
sleep. During sleep the System Controller and percutaneous lead must be immobi-
lized to reduce pulling on the exit site. The HeartMate Stabilization Belt or an
abdominal binder may be used to immobilize the perc lead and Controller
·
Patients should sleep or plan to sleep only when they are connected to the PBU.
·
Patients should not sleep on their stomach.
·
Keep a spare System Controller near a sleeping patient for convenient access in
the event of an emergency.
CLINICAL OPERATION AND PATIENT MANAGEMENT
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