Left Ventricular Assist Device (LVAD) Occupational Therapy Management
LVAD Video Summary
Source: Nucleus Medical Media
Disease Process for LVAD in Occupational Therapy
- The heart has 4 chambers: left & right atrium, left & right ventricle.
- The left ventricle pumps blood out through a large artery called the aorta.
- The aorta supplies the body with the oxygen and nutrients it needs.
- In left-sided heart failure, the left ventricle is not able to pump enough blood to the body.
- 2 types of left-sided heart failure:
- Diastolic left heart failure: The left ventricle cannot relax enough to fill the heart with blood.
- Systolic left heart failure (more common): The left ventricle cannot contract strongly enough to push blood to the body
- In end-stage heart failure, the heart is getting weaker and does not respond to medication.
- A Left Ventricular Assist Device (LVAD) helps the heart pump enough blood to the body.
- A small mechanical pump is implanted into the chest/abdomen and takes over the job of the weak left ventricle.
- Blood flows from the left ventricle -> inflow tube -> pump -> outflow tube -> aorta
- Driveline (cable which runs from the inside to the outside the body) is connected to a Control Unit (also outside the body).
- Control unit is a computer that controls the functions of the pump.
- Alerts the patient of any problems.
- Powered by battery pack(s).
- LVADs may be temporary for patients waiting for heart transplate, or if contraindicated, may be a longer-term system (“destination therapy“).
Battery Source Precautions
- While there are many different manufacturers and models of LVAD’s, they rely on a power source to function.
- LVADs can be powered by a power outlet or batteries.
- Most LVADs are plugged into 2 batteries.
- LVAD users are often independent in the management of their devices.
- If the situation arises: never unplug both batteries to switch them out for charged ones. Change them one at a time.
- Do not pull on or accidentally tug at drivelines.
- Be cautious and educate patients to be cautious during transfers or ambulating to minimize the risk fo line dislodgement.
- LVAD users may continue to be on blood thinners (long term) to prevent blood clots in the device.
- LVAD users will continue to take other heart failure medications: diuretics, blood pressure.
- The drive line creates an open-source for infection from the outside world (“exit site”) to the inside of the body, which will require monitoring.
Challenges Faced While Living With A LVAD
He described being approached and harassed by a small group of teenagers loudly accusIng him of being a “suicide bomber”.
Unable to leave the moving train, he attempted to distance himself and ignore the adolescents but conveyed being aware of “everybody looking” at him within the carriage.
- Sleep disruption
- Psychosocial: adjustment disorder, acute stress reaction, depressive episode, panic disorder, anxiety
- May be and has been mistaken for an explosive device. Educate, educate, educate!
- Educate security entities such as police, TSA, etc. who are likely to be more suspicious of these devices should know how to identify them.
- May lead to social engagement and isolation.
Occupational Therapy Intervention for LVAD
- Occupational therapists can educate LVAD users how to build strength to carry the LVAD accessories, change out the accessories, and perform any system-check maintenance requirements.
- LVAD users will need to carry their device and accessories with them in their daily routine.
- Pacing & energy conservation strategies
- Exercise & building strength
- Psychosocial (image)
ADLs & IADLs
- Regulating fluid intake (limiting vs. not enough)
- Diet: educate about the types of food that may impact blood thinners.
- Sleep comfort and not lying on LVAD
- Clothing: educate about LVAD clothing to make the device more discrete
- Showering: permitted once incisions have healed.
- LVAD manufacturers produce special shower bags.
- Equipment should not get wet!
- Cannot be submerged (at time of writing)
- Avoid swimming and contact sports
- Sex & intimacy: educate on how to avoid pressure on the external parts of the device, risks for pulling on the driveline, or excessive movement at the exit site.
- Pregnancy risk while on LVAD: currently no safe way to manage blood thinner medication with a fetus
- Driving: depends if cleared by a doctor initially, but can be a passenger in a vehicle
- When traveling, notify security personnel of the LVAD, carry a statement explaining the LVAD if possible for personnel not familiar with the device. Be sure to carry enough charged batteries to sustain the trip until you can recharge.