* Single hemodynamic values are rarely significant; monitor trends in these values and evaluate the whole clinical picture with the goals of recognizing early clues and intervening before problems escalate. CIRCULATORY ASSIST DEVICES * Circulatory assist devices (CADs) decrease cardiac work and improve organ perfusion when conventional drug therapy is no longer adequate. • CADs provide interim support in three types of situations: (1) the left, right, or both ventricles require support while recovering from acute injury, (2) the heart requires surgical repair but the patient must be stabilized, and (3) the heart has failed, and the patient is awaiting cardiac transplantation. NURSING MANAGEMENT: CIRCULATORY ASSIST DEVICES * Nursing care of the patient with a VAD is similar to that of the patient with an IABP. * Patients are observed for bleeding, cardiac tamponade, ventricular failure, infection, dysrhythmias, renal failure, hemolysis, and thromboembolism. * A patient with a VAD may be mobile and require an activity plan.
* Ideally, patients with CADs will recover; however, many patients die, or the decision to terminate the device is made and death follows. Both the patient and caregiver require psychologic support. Intraaortic Balloon Pump * The intraaortic balloon pump (IABP) provides temporary circulatory assistance to the compromised heart by reducing afterload (via reduction in systolic pressure) and augmenting the aortic diastolic pressure, resulting in improved coronary blood flow and perfusion of vital organs. * IABP therapy is referred to as “counterpulsation” because the timing of balloon inflation is opposite to ventricular contraction. * The IAPB assist ratio is 1:1 in the acute phase of treatment, that is, one IABP cycle of inflation and deflation for every heartbeat. * Complications of IABP therapy may include vascular injuries such as dislodging of plaque, aortic dissection, thrombus and embolus formation, and compromised distal circulation, acute renal failure. Indications: * Refractory unstable angina (when drugs have failed) * Short-term bridge to cardiac transplantation * Acute myocardial infarction with any of the following † • Ventricular aneurysm accompanied by ventricular dysrhythmias • Acute ventricular septal defect • Acute mitral valve dysfunction • Cardiogenic shock • Refractory chest pain with or without ventricular dysrhythmias Ventricular Assist Devices * Ventricular assist devices (VADs) provide left, right, or biventricular support for failing hearts for a longer-term (usually months) while allowing more mobility than the IABP. * VADs are inserted into the path of flowing blood to augment or replace the action of the ventricle. Some VADs are implanted (e.g., peritoneum), and others are positioned externally. * Indications include (1) failure to wean from CPB or postcardiotomy cardiogenic shock, (2) a bridge to recovery or cardiac transplantation Nursing Management: * Nursing care of the patient with a VAD is similar to that of the patient with an IABP. Observe the patient for bleeding, cardiac tamponade, ventricular failure, infection, dysrhythmias, renal failure, hemolysis, and thromboembolism.
- Fall '16