Authors (including presenting author) :
Tang SS, Lam SL, Hui YC, Wong LY
Affiliation :
Department of Cardiothoracic Surgery, Queen Mary Hospital
Introduction :
Implantable left ventricular assist device (LVAD) therapy is proved to promote the survival of patients with advanced heart failure. A comprehensive pre-implant nursing care aimed to promote all LVAD candidates’ outcome in our unit. More favorable outcome in stable patient than “crash and burn” or inotrope-dependent patients after LVAD implantation is proved by many studies; the effect of our nursing care is still questioned by nursing staff, patients and family members.
Objectives :
To evaluate the effectiveness of pre-implant nursing care on critical patients with LVAD implantation in terms of length of stay (LOS) in ICU, day of extubation and mobilization.
Methodology :
22 patients with advanced heart failure had LVAD implantation during 2016-2018. The day of extubation, mobilization and length of stay in CTS-ICU were measured and analyzed. 5 patients were excluded due to secondary bleeding, stroke and one due to AAA repair.
Pre-implant nursing care aiming to optimize pre-implant comorbid conditions, minimize post-operative adverse events and enhance survival was applied. Apart from preserving right ventricular function by inotropic therapies or dialysis, other end-organ function such as renal, hepatic and neurological were important to optimize. Nutrition optimization was begun initially and continued throughout the whole perioperative period. Frequent and small meals were recommended and home food was allowed to encourage intake. Education on hand hygiene was emphasized for infection control in addition to prophylactic antimicrobial therapy. As part of psychological preparation, post-operative plan was introduced to patient and family, self-care was empowered and arranged LVAD peer group visit for sharing.
Result & Outcome :
Results:
The mean day of extubation is post-operative day (POD) 2 (Range: POD1-3)
The mean day of starting mobilization is POD3 (Range: POD1-4)
The mean LOS in ICU is 10 days (Range: 2-13).
There is no significant difference between patients with and without mechanical circulatory support Conclusion:
Regardless of pre-implant conditions, the patient outcome in terms of LOS in ICU, day of extubation and mobilization were promoted, the effectiveness of pre-implant nursing care on patients with LVAD implantation is inspiring and convincing to nursing staff, LVAD candidates and their family. Continuity of care will be provided for subsequent LVAD candidates in the future.
Co-location with:
