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.

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

• 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.

Sources:

https://www.ucsfhealth.org/education/living_with_a_ventricular_assist_device/#2

https://www.ncbi.nlm.nih.gov/pubmed/30217655