Title/Description: Nursing Care of Patients with Ventricular Assist Devices

Transcription

1 University of Kentucky / UK HealthCare Policy and Procedure Policy # NR08-11 Title/Description: Nursing Care of Patients with Ventricular Assist Devices Purpose: To establish requirements and responsibilities for registered nurses who provide care for patient with ventricular assist devices. Policy Procedure Emergent Care of all VAD patients Education and Competencies Nursing responsibilities for the patient with a Ventricular Assist Device Transporting the VAD patient References Persons and Sites Affected Policies Replaced Effective Date Review/Revision Dates Policy Ventricular Assist Device (VAD) certified staff shall care for patients with mechanical ventricular assist devices using the procedures below. Designated staff shall complete appropriate training and have documented evidence of the training before caring for patients with these devices. Procedure Emergent Care of all VAD patients 1. Defibrillation or Cardioversion of MCS patients is permitted per ACLS guidelines. 2. Chest compressions are permitted in a code situation if the pump has failed, or as directed by the physician. Education and Competencies 1. General (a) Competency training shall be organized by Staff Development and annual recertification shall be required. (b) Initial training and recertification shall be documented in staff educational files. Policy # NR08-11 Nursing Care of Patients with Ventricular Assist Devices 1

2 (c) Mechanical Circulatory Support (MCS) Coordinators will conduct the initial certification and all recertification in compliance with current guidelines, protocols and policies as set forth by the University of Kentucky Medical Center. (d) Training shall include but is not limited to: i. Theory of mechanical circulation. ii. Safe operation of all portable VAD equipment. iii. Troubleshooting. iv. Basic alarms. v. Hands on operation and competency. 2. Cardiovascular Thoracic Intensive Care Unit (CVTICU) Nursing Staff: content including Axial Flow, Extracorporeal Flow, and Centrifugal Flow, theory of operations, clinical demonstration, along with optional online instruction. (b) Previously certified staff shall attend a half day recertification course, to include equipment updates, clinical demonstrations and optional online instruction. (c) The CVTICU nurse shall have three months of previous nursing experience to be eligible for this course. 3. Progressive Care and Telemetry Nursing Staff 4. Perfusion Staff: content including Axial Flow, Extracorporeal Flow, and Centrifugal Flow, theory of operations, clinical demonstration, along with optional online instruction. (b) Previously certified staff shall attend a half day recertification course, to include equipment updates, clinical demonstrations and optional online instruction 5. Dialysis Nursing Staff: (a) New staff shall attend a two hour MCS training class specifically targeted for the dialysis nurse, which includes didactic content of Axial Flow, Extracorporeal Flow, Centrifugal Flow theory of operations, clinical demonstration, along with optional online training. (b) Previously certified staff shall attend a one hour recertification course, to include training updates, clinical demonstration and optional online instruction. 6. Paramedic Transport Team: Policy # NR08-11 Nursing Care of Patients with Ventricular Assist Devices 2

3 7. Rapid Response Team: 8. Physical Therapy & Occupational Therapy Staff: (a) Staff shall attend a one hour MCS training class annually, which includes a general didactic overview including Axial Flow, Extracorporeal flow, and Centrifugal flow theory of. 9. Emergency Department Paramedic Staff: (c) These Paramedic Staff are intended to assist the Emergency Department for monitoring and transporting of the VAD patient in the absence of the MCS Coordinator. 10. VAD Awareness: (a) Designated support staff is encouraged to complete online web based training annually (WBT). (b) VAD Awareness is intended to familiarize staff with basic VAD operations, interventions and emergency contact information in the event of a patient encounter. (c) VAD Awareness is available on the Mechanical Circulatory Support Clinician Link for review at any time. Nursing responsibilities for the patient with a Ventricular Assist Device 1. Immediately following placement of an assist device, vital signs shall be assessed every 15 minutes for four assessments; then every 30 minutes for two assessments; and then every hour for a minimum of eight hours. Monitoring of other parameters such as CCO, SvO2, PAP, etc. will be performed per unit specific guidelines. 2. After the initial post op period, vital signs will be monitored per ICU/telemetry guidelines. 3. For device, driveline or patient education concerns, the nurse may contact the MCS coordinator Policy # NR08-11 Nursing Care of Patients with Ventricular Assist Devices 3

4 4. Percutaneous cannula exit site dressings shall be changed every 48 hours or as ordered by the physician. Initial dressing change should occur within 24 hours postoperatively or sooner if dressing is saturated. The nurse shall evaluate the driveline site with each dressing change and document findings. Transporting the VAD patient VAD patients can be transported with one of the following present: 1. VAD Trained RN 2. Rapid Response Trained Staff 3. EMT trained Staff 4. MCS Coordinator/Perfusionist References 1. AACN Procedure Manual Care of Ventricular Assist Devices, 5 th ed, Advanced Practice and Guidelines for HeartMate Destination Therapy: Thoratec CentriMag Primary Console Operating Manual and Blood Pump Instructions for Use: September Thoratec Clinical Operation and Patient Management of HeartMate (Bridge to Transplantation) and VAD (Short Term or Acute Assist Device):2007 Policy # NR08-11 Nursing Care of Patients with Ventricular Assist Devices 4

5 Persons and Sites Affected Enterprise Chandler Good Samaritan Kentucky Children s Ambulatory Department Nursing Policies Replaced Chandler HP Good Samaritan Kentucky Children s CH Ambulatory KC Other Effective Date: 03/2000 Review/Revision Dates: 01/2011, 09/2011, 09/16/2013 Approval by and date: Name Mark A. Bradley, Senior Nurse Clinician, Gill Heart Institute, Review Team Leader Name E. Darlene Spalding, Senior Nurse Administrator, UK HealthCare Good Samaritan Hospital Name Kathleen Kopser, Senior Nurse Administrator, Chandler Hospital Name Colleen Swartz, Chief Nurse Executive Policy # NR08-11 Nursing Care of Patients with Ventricular Assist Devices 5