Left Ventricular Assist Device (LVAD) Occupational Therapy Management

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.

LVAD Purpose

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“).

LVAD Precautions

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.

Driveline

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.

Medications

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.

Infection

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.

General Interventions

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.