10
9
8
7
6
5
4
3
2
1
Appendix
Reference
Guides
Alarms and
Emergencies
Patient
Management
Surgical
Implant and
Explant
Monitor
Peripherals
and
Accessories
HVAD
®
Pump Overview
Introduction
126 HVAD® Instructions for Use
7.1 Postoperative Management (continued)
7.1.4 Right Heart Failure
Right heart failure is common in patients receiving LVADs. Right heart failure usually develops
(RAP) with concurrent decreases in the pulmonary capillary wedge pressure (PCWP) and LVAD
should be given to increase the RAP to 15-18mmHg. This can be accomplished quickly and
easily in the operating room while the patient is on cardiopulmonary bypass. Increasing the RAP
drug support in conjunction with pulmonary vasodilators such as nitric oxide is usually effective.
If volume and pharmacological therapy fail, a right ventricular assist device (RVAD) should be
considered. Late right heart failure (weeks to months) post LVAD implant is unusual but would
manifest itself with similar but less acute symptoms. The etiology of late right heart failure may be
a progression of chronic heart disease such as coronary artery disease and/or right ventricular
7.1.5 Arrhythmias
The HVAD
®
Pump functions most effectively when adequate and stable amounts of preload
are available. A stable supraventricular rhythm helps to optimize right heart performance and
provide the HVAD
®
Pump with preload. Many heart failure patients will have permanent
are often needed in the early postoperative period.
7.1.6 Infection Control Guidelines*
For prevention of infection, remove unnecessary IV lines and replace old IV lines before HVAD
®
Pump implantation. Administer antimicrobial prophylaxis based on the hospital’s nosocomial
enterococcus. Use pre-operative scrub with antiseptic the night before and again the morning
of the operation. After HVAD
®
Pump implantation, continue systemic antimicrobials prophylaxis
for 48 to 72 hours. Remove mediastinal and pleural drains as soon as appropriate. Early
extubation, removal of monitoring lines, and patient ambulation are encouraged. Rapid
restoration of oral nutrition should be attempted using tube feeding if necessary. Turning the
patient side to side can start once the patient is clinically stable. Physical therapy and active
decrease infection include frequent hand washing and strict aseptic technique during contact
with invasive lines and during HVAD
®
Pump dressing changes.
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