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.
Author(s): Scott Stewart, Peggy Blood
Publisher: Springer
Year: 2022
Language: English
Pages: 289
City: Cham
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
