HeartMate XVE LVAD
VAD Resource Team
University of Washington Medical Center
VAD Resource Team
pinoy 598-6500
5SE Teddy Villamarin
esuver 598-4500
5NE Eileen Suver
janie 598-7369
5SE Janie Shively
kiwi 598-6500
5SE Nicola Kaye
kegreen 598-4500
5NE Kristina Green
sagreco 994-4535
5NE/5SE Sheryl Greco
sandrus 994-6986 Cardiac Surgery Shauna Andrus Email Pager/Phone
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
HeartMate Candidates
•
Transplant candidate:•
dependent on vasopressor supportOR
•
incomplete response to continued vasopressor support•
Approved for ‘Destination Therapy’Pump
Percutaneous Tube
Vent Adapter
Weight: 3.74 lbs Pump volume: 83 ml Rate: Up to 120 Flow: Up to 10 L/min TitataniumMotor with 2 bearings Vent port
Two tissue valves: Inflow & Outflow
Percutaneous Tube
&
Vent Adapter
AVOID:
System Controller
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
Power Base Unit (PBU)
& System Monitor
Power Base Unit
PBU Internal battery Battery charger •AC Fail •Low Batt •Alarm resetScreen of System Monitor
Pump Rate: Rate PUMP is beating Flow: Cardiac output Stroke volume: ml/beat FUNCTION BUTTONSFIXED 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.
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
• 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
1. Power Cable Disconnect
MOST COMMON
Routine alarm that sounds when power source (battery or outlet) is changed or only one power source connected
YELLOW WRENCH
2. Controller Malfunction
2nd MOST COMMON
Caused by a malfunction in the system controller
*Inoperative Controller = ½ wrench*
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 ¼
¼ replace the extensionreplace the extension •
• High blood pressure to pump against High blood pressure to pump against ¼
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 ¼¼ correct by attaching the system correct by attaching the system
monitor and changing the backup rate
•
Steady tone alarm•
Preceded and accompanied by a yellow wrench alarm•
May be reset for 2 minutesRED HEART: HAZARD ALARMS
•
May be silenced for 24 hours•
1 beep per secondRED HEART
1. 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
•
Check connections¼
most likely culprit is the percutaneous tube connection to the system controller•
Check your patient¼ you may need to hand pump
•
Check the vent port to insure it is not occluded•
Try changing the power source•
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 fromRED HEART
2. Low Stroke Volume: < 25 ml 3. 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 problemRED HEART CAUSES
•
Severe RV failure ¼ consider inotropes•
Extreme low blood volume ¼ assess for bleeding or fluid loss, replace fluids•
VT, VF or Asystole ¼ ACLS protocolsEXCEPTION: NO chest compressions
(may dislodge outflow conduit)
•
LV inflow cannula obstructionXVE System Controller
disconnected from the percutaneous tube
FLASHING YELLOW BATTERY
RED HEART
YELLOW WRENCH
Steady tone
CANNOT BE SILENCED
•
Check system controller cable connection to percutaneous tubeBATTERY ALARMS
•
Flashing Yellow Battery•
No tone•
Yellow Battery•
Once-per-second•
Red BatteryFLASHING YELLOW BATTERY
No 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 alarmLow Voltage Advisory
Less than 15 min of battery power remain
YELLOW BATTERY
Once-per-second BEEP
RED BATTERY:
Steady tone
•
Pump defaults to POWER SAVER MODE: 50 bpm9 Patient may be symptomatic @ this rate if used to faster rate
•
Immediately switch to an alternate power source or prepare to hand pumpLow Voltage Alarm
EMERGENCIES
•
VT/VF
Monitor BP; Flows; Cardiovert/Defibrillate
•
BLOOD FROM EXIT SITE
STAT page CT surgeon &/or fellow
•
RED HEART
Trouble shoot; be prepared to hand pump STAT page CT surgeon &/or fellow
IF LVAD MOTOR STOPS
< 5 minutes
•
Troubleshoot and get it workingagain
•
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/FellowPneumatic Console
Can 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
