CVP Exam II Flashcards by Carley Cronen

What are the signs/symptoms of left sided heart failure?

shortness of breath, cough, lung crackles, wheezing, tachypnea, restlessness, confusion, orthopnea, tachycardia, fatigue, cyanosis

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What are the signs/symptoms of right sided heart failure?

fatigue, peripheral edema, ascites, enlarged liver and spleen, distended jugular veins, GI distress (maybe anorexia), weight gain, dependent edema

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[systolic/diastolic] heart failure is defined as a pump failure to be able to eject blood.

systolic heart failure

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[systolic/diastolic] heart failure is reduced volume content due to stiff walls reducing volumes to eject.

diastolic heart failure

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Class I Heart Failure

no limitation of physical activity, normal activity doesn’t cause symptoms (i.e. fatigue, palpitation, or shortness of breath)

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Class II Heart Failure

slight limitation of physical activity, comfortable at rest, normal activity causes symptoms (i.e. fatigue, palpitation, or shortness of breath)

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Class III Heart Failure

marked limitation of physical activity, comfortable at rest, less than normal activity causes symptoms (i.e. fatigue, palpitation, or shortness of breath)

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Class IV Heart Failure

unable to carryout physical activity without discomfort, symptoms (i.e. fatigue, palpitation, or shortness of breath) at rest, with increase in symptoms with any activity.

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Those that are older than 65 years old usually receive an LVAD for ______ ______ in order to prolong their life and enhance their QOL.

destination therapy

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Those that are younger than 65 usually receive a LVAD to prolong their life while they wait for a ____ ____.

heart transplant

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What are some indications for mechanical circulatory support (MCS)? (4)

symptoms, dependence on ionotropes, functional QOL, and medically optimized (i.e. in hospital >60 days and still in cardiogenic shock)

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What are some characteristics of LVAD candidates? (i.e. cardiopulmonary, respiratory, musculoskeletal, and NS)

Cardiopulmonary: Impaired activity tolerances, impaired peripheral artery quality (edema), claudification, impaired heart rate recovery time, reduced cardiac output, increased lactic acid
Respiratory: Poor V-Q perfusion, pulmonary congestion, decreased oxygen saturation, increased pulmonary resistance
Musculoskeletal: reduction of skeletal muscle mass, affecting insulin resistance, shift of increased anaerobic muscle fibers, (typeI I),change in muscle metabolism
Nervous System: Abnormal activation of the SNS which advances heart failure, baro and chemo receptor reflexes are changed,

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Reasons why someone wouldn’t be a good candidate for an LVAD or mechanical circulatory device? (7)

disability level impacts recovery, cognition + family support limits recovery, anticoagulation prohibited, pulmonary disease, multiorgan failure, BMI>35, and cancer

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The mechanical circulatory support device that is designed to assist the left ventricle pump oxygen rich blood from the lungs to the rest of the body is the [LVAD/RVAD].

LVAD

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The mechanical circulatory support device that is designed to assist the right ventricle pump blood from the right side of the heart to the lungs is the [LVAD/RVAD].

RVAD

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The mechanical circulatory support device that is designed to support both the right and left sides of the heart is the [BiVAD/TAH].

BiVAD

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The mechanical circulatory support device that is designed to replace both heart ventricles and four valves is the [BiVAD/TAH].

TAH (Total artificial heart)

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Mechanical circulatory support devices are approved indications for what 3 things? (according to the FDA and payment perspective)

bridge to: transplant, decision, or recovery

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The speed of the VAD is set so the MAP equals what?

70-90

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The VAD has difficulty working against pressures where?

in the aorta

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What can cause hemodynamic changes in a VAD? (5)

pump thrombosis, hypovolemia, orthostatic hypotension, hypertensive crisis, or a suction event

T/F VAD precautions are the same as sternal precautions.

False

What are VAD precautions?

week 1-6: don’t lift, push, or pull anything >8lbs (i.e. gallon of milk)

week 7-12: don’t lift, push, or pull anything >20lbs

week 12+: don’t lift, push, or pull anything >50lbs

What are possible LVAD complications? (9)

Arrhythmias
Gastrointestinal vascular bleeding
Cerebral vascular accident
Pump thrombosis
Drive line infections
Inflow obstruction/suction
Severe deconditioning
Right ventricular failure
Aortic insufficiency

What are some outcome measures to use post-op? (6)

Comparison of pre-surgical measures (i.e. SPPB, chair-rise, gait, and balance), Borg RPE, dyspnea scale, AMPAC 6 Clicks, 2-Minute Step Test, 6-Minute Walk Test

What should you include in documentation after treatment?

device parameters (i.e. flow, power) vitals (i.e. BP, HR, O2) Alarms that occurred during session BORG RPE

What are some risks/adverse events that may occur after implantation?

bleeding, infection, tamponade, ventricular arrhythmias, renal failure, right ventricular failure, neurological complications, hemolysis, thrombus, device failure, higher risk for myopathies, and suicide

With a total artificial heart (TAH), what “pump”/machine do they carry? How much can that weigh?

Freedom Driver 15.5 lbs (with backpack)

With a TAH, you would not have a normal [BP and ECG/BP or ECG]

BP and ECG

With a TAH, what characteristics do patients have?

low hemoglobin (6-8 g/dl), INR between 2.5-3.5, 9.5 L blood pumped/min, pulse set by freedom driver, and they take aspirin and coumadin

What does ECMO stand for?

extracorporeal membrane oxygenation

[LVAD/ECMO] is an external device that oxygenates a hospitalized critically ill patient's blood, removes CO2, and provides blood flow

ECMO

When is ECMO utilized?

cases of lung or cardiac damage, cystic fibrosis, meconium aspiration, waiting for heart transplant, and waiting for heart to heal

[VA ECMO/VV ECMO] is used when cardiac support is needed. The blood is pulled from venous circulation and returned into arterial circulation. Blood is non-pulsatile and mostly bypasses the heart and lungs.

VA ECMO

[VA ECMO/VV ECMO] is used when there is adequate cardiac function and the support is needed for respiratory reasons.

VV ECMO

[Pump flow/Sweep flow] is the rate at which the pump is moving the blood in L/min.

pump flow

[Pump flow/Sweep flow] is the rate at which oxygen is moving through the membrane in L/min.

sweep flow

[FiO2/SvO2] is the amount of oxygen being delivered to the circuit.

FiO2

[FiO2/SvO2] is the amount of oxygen left in the blood after one circuit through the body (must be 40% for therapy, but 60% is ideal at rest)

SvO2

What are the indications for ECMO? (4)

heart failure cardiogenic shock, acute coronary syndrome, myocarditis, cardiomypathy, failed cardiopulmonary resuscitation, failed heart surgery, cystic fibrosis

Describe the following ECMO configuration. right internal jugular vein and right axillary artery

ECMO in this vein and artery. No ROM of right shoulder but patients can stand and transfer.

Describe the following ECMO configuration. femoral cannulation

ECMO placed in femoral artery

Describe the following ECMO configuration. central cannulization

ECMO placed below xiphoid in the right atrium and ascending aorta

How is a patients increased workload compensated for by a specialist during activity with a patient on ECMO?

increase in sweep flow, FiO2, and pump speed

What are limiting factors for rehab with patients on ECMO? (2)

patient's O2 consumption (SvO2) and fluid status

Venoarterial (VA) ECMO can support up to \_\_\_\_% of the native cardiac output.

80%

[VV/VA] ECMO has fewer complications than [VV/VA] ECMO.

VV has fewer than VA

What are some possible complications with ECMO?

* Decannulation * Hemorrhagic stroke * Bleeding, infection * Emboli/thrombosis * Lower extremity ischemia * Lower extremity compartment syndrome * Lower extremity amputation * Acute kidney injury * Rethoracotomy or surgical exploration of the thoracic cavity * Vascular tear * Gastrointestinal bleeds * ECMO patients are at increased bleeding risk secondary to probable heparin use for anti-coagulation

How can you assess patient tolerance for therapy with ECMO and VAD?

monitor physical signs and symptoms (i.e. RR, headache, nausea, color) monitor for mental status changes (i.e. confusion, agitation) patient's subjective report (i.e. BORG or RPE scale)

Who should manage the ECMO lines and machine when working with patient?

ECMO specialist