Left Ventricular Assist Device (LVAD) Occupational Therapy Management

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

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.

Sources:

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

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

OTDUDE
About the Author: Jeff is the lead author and editor of OTDUDE.com, where he covers all things Occupational Therapy.