VENTRICULAR ASSIST DEVICES AND NURSING CARE

Cestari, Virna Ribeiro Feitosa; Pessoa, Vera Lúcia Mendes de Paula; Moreira, Thereza Maria Magalhães; Florêncio, Raquel Sampaio; Barbosa, Islene Victor; Ribeiro, Silvania Braga

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Brasil

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Original Article • Texto contexto - enferm. 26 (3) • 2017 • https://doi.org/10.1590/0104-07072017000980016 copy

VENTRICULAR ASSIST DEVICES AND NURSING CARE

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

describing the functioning, benefits and complications associated with the use of ventricular assist devices and identifying the interventions performed by nurses in the care of patients using this device, according to presented evidence.

Method:

an integrative review of articles collected in health databases conducted in February 2015. The descriptors used were heart diseases, heart-assist devices and nursing. We identified 34 articles, which were then submitted to thematic analysis.

Results:

ventricular assist devices function as mechanical pumps promoting adequate cardiac output. Their main benefit is hemodynamic stabilization. The most common complication is infection. Health education, emotional support, outpatient care and curative care are the main care actions performed by nurses.

Conclusion:

evidence confirms improvement in survival rates of patients with severe heart failure with the use of ventricular assist devices, reiterating the importance of expanding this technology in Brazil as a possibility for treatment.

DESCRIPTORS:
Cardiac disorders; Cardiac insufficiency; Artificial heart; Nursing; Cardiovascular nursing; Nursing care

Study	Journal/year	Methodological design	LE	Topic approached	Nursing actions	Justification for Nursing actions
A1¹³13 Savage L, Murphey J, Joyce K. Developing and maintaining competency with circulatory assist device: how to meet the challenge. Prog Transpl [Internet]. 2010 [cited 2016 Aug 09]; 20:125-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20642169 https://www.ncbi.nlm.nih.gov/pubmed/2064...	Prog Transpl/ 2010	Experience Report	V	Preparing nurses for the Total Artificial Heart Program (TAH-t)	Creation/implementation of protocols and standard care; knowledge regarding the ethical aspects that involve the theme	Development and maintenance of professional competence
A2¹⁴14 Ziemba EA, John R. Mechanical circulatory support for bridge to decision: which device and when to decide. J Card Surg [Internet]. 2010 [cited 2016 Aug 12]; 25:425-33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20412350 https://www.ncbi.nlm.nih.gov/pubmed/2041...	J Card Surg/ 2010	Review	V	Expansion of scientific knowledge about the use of VAD: components, associated benefits and complications	-	-
A3¹⁵15 Kaan A, Toung QR, Cockell S, Mackay M. Emotional expereriences of caregivers of patients with a ventricular assist device. Prog Transpl [Internet]. 2010 [cited 2016 Aug 12]; 20:142-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20642172 https://www.ncbi.nlm.nih.gov/pubmed/2064...	Prog Transpl/ 2010	Hermeneutic phenomenology	V	Emotional experiences of caregivers of patients with VAD	Evaluation of the perception of patients, family members, caregivers and nurses	Possibility of interventions based on the actual situation
A4⁸8 Gelape CL; Pham SM. Os avanços no suporte circulatório mecânico no tratamento da insuficiência cardíaca. Arq Bras Cardiol [Internet]. 2012 [cited 2016 Aug 11]; 8(2):36-43. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2012000200018 http://www.scielo.br/scielo.php?script=s...	Prog Transpl/ 2010	Case study	IV	Expansion of scientific knowledge about the use of VAD: components, associated benefits and complications	-	-
A5¹⁶16 Lachman VD. Left ventricular assist device deactivation: ethical issues. Medical-Surgical Nurs [Internet]. 2011 [cited 2016 Aug 11]; 20(2):98-100. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21560962 https://www.ncbi.nlm.nih.gov/pubmed/2156...	Medical-Surgical Nurs/ 2011	Descriptive	V	The use of VADs and ethical aspects	Creation/implementation of protocols and standard care; knowledge of the ethical aspects involving the theme	Development and maintenance of professional competence
A6¹⁷17 Elhenawy AM, Algarni KD, Rodger M, Maclever J, Maganti M, Cusimano RJ, et al. Mechanical circulatory support as a bridge to transplant candidacy. J Card Surg [Internet]. 2011 [cited 2016 Aug 15]; 26:542-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21883463 https://www.ncbi.nlm.nih.gov/pubmed/2188...	J Card Surg/ 2011	Case-control study	IV	Re-evaluation of VAD patients eligible for transplant	-	-
A7¹⁸18 Swetz KM, Freeman MR, AbouEzzeddine OF, Carter KA, Boilson BA, Ottenberg AL, et al. Palliative medicine consultation for preparedness planning in patients receiving left ventricular assist devices as destination therapy. Mayo Clin Proc [Internet]. 2011 [cited 2016 Aug 14]; 86(6):493-500. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21628614 https://www.ncbi.nlm.nih.gov/pubmed/2162...	Mayo Clin Proc/ 2011	Retrospective	V	Implementation of palliative medicine consultations	-	-
A8¹⁹19 Gilmore H, Newall F. The experience of parentes and children where children have been supported with a ventricular assist device as a bridge to heart transplantation. Pediatr Cardiol [Internet]. 2011 [cited 2016 Aug 12]; 32:772-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21479667 https://www.ncbi.nlm.nih.gov/pubmed/2147...	Pediatr Cardiol/ 2011	Descriptive	V	Children's experience awaiting transplant with VAD and family members	Evaluation of the perception of patients, family members, caregivers and nurses	Possibility of interventions based on the actual situation
A9²⁰20 Casida JM, Davis JE, Brewer RJ, Smith C, Yarandi H. Sleep and daytime sleepiness of patients with left ventricular assist devices: a longitudinal pilot study. Prog Transpl [Internet]. 2011 [cited 2016 Aug 13]; 21:131-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21736242 https://www.ncbi.nlm.nih.gov/pubmed/2173...	Prog Transpl/ 2011	Longitudinal	IV	Sleep pattern and quality	Analysis of sleep quality and pattern	Reduction of complications and health promotion
A10²¹21 Marcuccilli L; Casida JM. From insiders' perspectives: adjusting to caregiving for patients with left ventricular assist devices. Prog Transpl [Internet]. 2011 [cited 2016 Aug 20]; 21:137-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21736243 https://www.ncbi.nlm.nih.gov/pubmed/2173...	Prog Transpl/ 2011	Hermeneutic phenomenology	V	Lifestyle adjustments of caregivers of adults with VAD	Evaluating the perception of patients, family members, caregivers and nurses	Possibility of interventions based on the actual situation
A11²²22 Marcuccilli L; Casida JJ. Overcoming alterations in body image imposed by the left ventricular assist device: a case report. Prog Transpl [Internet]. 2012 [cited 2016 Aug 15]; 22:212-6. Available from: http://journals.sagepub.com/doi/abs/10.7182/pit2012579 http://journals.sagepub.com/doi/abs/10.7...	Prog Transpl/ 2012	Experience Report	V	Alteration of body self-perception imposed by VAD	Evaluating the perception of patients, family members, caregivers and nurses	Possibility of interventions based on the actual situation
A12²³23 Casida JM, Pastor J. Practice pattern and professional issues of nurse practitioners in mechanical circulatory support programs in the United States: a survey report. Prog Transpl [Internet]. 2012 [cited 2016 Aug 14]; 22:229-36. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22951499 https://www.ncbi.nlm.nih.gov/pubmed/2295...	Prog Transpl/ 2012	Descriptive	V	Nurses health care practice in caring for the patient with VAD	Assessment and management of health problems: interpretation/request for laboratory tests and other diagnostic procedures; realization of physical examination; monitoring vital signs; patients admissions and discharges; home visits	Patient monitoring to prevent or diagnose early complications associated with the use of VAD
A13²⁴24 Chokshi A, Drosatos K, Cheema FH, Ki R, Khawaja T, Yu S, et al. Ventricular assist device implantation corrects myocardial lipotoxicity, reverses insulin resistance, and normalizes cardiac metabolismo in patients with advanced heart failure. Circulation [Internet]. 2012 [cited 2016 Aug 12]; 125:2844-53. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464497/pdf/nihms386125.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Circulation/ 2012	Case-control study	IV	Benefits: reduction of myocardial lipotoxicity, reversing insulin resistance and cardiac metabolism normalization in patients with advanced heart failure	-	-
A14²⁵25 Cannon A, Elliott T, Ballew C, Cavey J, O'Shea G, Franzwa J, et al. Variability in infection control measures for the percutaneous lead among programs implanting long-term ventricular assist devices in the United States. Prog Transpl [Internet]. 2012 [cited 2016 Aug 16]; 22:351-9. Available from: http://journals.sagepub.com/doi/abs/10.7182/pit2012612?journalCode=pitb http://journals.sagepub.com/doi/abs/10.7...	Prog Transpl/ 2012	Exploratory and descriptive	V	Definition of existing practices (standardization or protocol based on experts' opinions) to prevent infections	-	-
A15²⁶26 Casida JM, Brewer RJ, Smith C, Davis JE. An exploratory study of sleep quality, daytime function, and quality of life in patients with mechanical circulatory support. Int J Artif Organs [Internet]. 2012 [cited 2016 Aug 16]; 35(7):531-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22661110 https://www.ncbi.nlm.nih.gov/pubmed/2266...	Int J Artif Organs/ 2012	Exploratory and descriptive	V	Sleep pattern and quality	Analysis of sleep quality and pattern	Reduction of complications and health promotion
A16⁸8 Gelape CL; Pham SM. Os avanços no suporte circulatório mecânico no tratamento da insuficiência cardíaca. Arq Bras Cardiol [Internet]. 2012 [cited 2016 Aug 11]; 8(2):36-43. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2012000200018 http://www.scielo.br/scielo.php?script=s...	Arqu Bras Cardiol/ 2012	Review	V	Expansion of scientific knowledge about the use of VAD: components, associated benefits and complications	-	-
A17²⁷27 Breda JR, Gaia DF, Macedo M, Motta P, Martins M, Alves D, et al. Ventricular assist device implantation with CentriMag VAS for biventricular mechanical support. Braz J Cardiovasc Surg [Internet]. 2013 [cited 2016 Aug 10]; 28(3):401-4. Available from: http://www.scielo.br/pdf/rbccv/v28n3/v28n3a16.pdf http://www.scielo.br/pdf/rbccv/v28n3/v28...	Rev Bras Cirur Cardiovasc/ 2013	Case study	IV	Use of ventricular assistance after refractory cardiogenic shock	-	-
A18²⁸28 Marcuccilli L, Casida J, Peters RM. Modification of self-concept in patients with a leftventricular assist device: an initial exploration. J Clin Nurs [Internet]. 2013 [cited 2016 Aug 9]; 22:2456-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23506318 https://www.ncbi.nlm.nih.gov/pubmed/2350...	J Clin Nurs/ 2013	Hermeneutic phenomenology	V	Alteration of body self-perception imposed by VAD	Evaluating the perception of patients, family members, caregivers and nurses	Possibility of interventions based on the actual situation
A19²⁹29 Teempleton DL, John R, Painter P, Kelly AS, Dengel DR. Effects of the left ventricular assist device on the compliance and distensibility of the carotid artery. Heart Vessels [Internet]. 2013 [cited 2016 ago 15]; 28:377-84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22875409 https://www.ncbi.nlm.nih.gov/pubmed/2287...	Heart Vessels/ 2013	Case-control study	IV	Effects of VAD in carotid artery compliance	-	-
A20⁹9 Aggarwal A, Kurien S, Coyle L, Siemeck R, Tatooles A, Pappas P, et al. Evaluation and management of emergencies in patients with mechanical circulatory support devices. Prog Transpl [Internet]. 2013 [cited 2016 Aug 10]; 23:119-27. Available from: http://pit.sagepub.com//doi/abs/10.7182/pit2013848 http://pit.sagepub.com//doi/abs/10.7182/...	Prog Transpl/ 2013	Systematic review	II	Expansion of scientific knowledge about the use of VAD: its components, associated benefits and complications	-	-
A21³⁰30 Mondal NK, Sorensen E, Hiivala N, Feller E, Griffith B, Wu ZJ. Oxidative stress, DNA damage and repair in heart failure patients after implantation of continuous flow left ventricular assist devices. Int J Med Sci [Internet]. 2013 [cited 2016 Aug 11]; 10(7):883-93. Available from: http://www.jhltonline.org/article/S1053-2498(13)00440-3/pdf http://www.jhltonline.org/article/S1053-...	Int J Med Sci/ 2013	Case-control study	IV	Complications: oxidative stress, DNA damage and repair	-	-
A22³¹31 Gibson JA, Henderson A, Jillings C, Kaan A. Nursing patients with ventricular assist devices: an interpretive description. Prog Transpl [Internet]. 2013 [cited 2016 Aug 13]; 23:147-52. Available from: http://journals.sagepub.com/doi/abs/10.7182/pit2013766?journalCode=pitb http://journals.sagepub.com/doi/abs/10.7...	Prog Transpl/ 2013	Descriptive	V	Nurses health care practice in caring for the patient with VAD	Evaluating the perception of patients, family members, caregivers and nurses	Possibility of interventions based on the actual situation
A23³²32 Nienaber JJC, Kusne S, Riaz T, Walker RC, Baddour LM, Wright AJ, et al. Clinical manifestations and management of left ventricular assist device: associated infections. Clin Infect Dis [Internet]. 2013 [cited 2016 Aug 10]; 57(10):1438-48. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805171/pdf/cit536.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Clin Infect Dis/ 2013	Retrospective	V	Manifestations and actions associated with the occurrence of infections	-	-
A24³³33 Gordon RJ, Weinberg AD, Pagani FD, Slaughter MS, Pappas PS, Naka Y, et al. Prospective, multicenter, study of ventricular assist device infections. Circulation [Internet]. 2013 [cited 2016 Aug 12]; 127:691-702. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3695607/pdf/nihms440295.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Circulation/ 2013	Prospective	V	Risk factors for infection in the pre-, intra-and postoperative periods of VAD implantation	-	-
A25³⁴34 Kroekel PA, George L, Eltoukhy N. How to manage the patient in the emergency department with a left ventricular assist device. J Emerg Nurs [Internet]. 2013 [cited 2016 Aug 12]; 39:447-53. Available from: http://www.jenonline.org/article/S0099-1767(12)00013-X/pdf http://www.jenonline.org/article/S0099-1...	J Emerg Nurs/ 2013	Case study	IV	Management of patients with VAD in the emergency department	Intervention in emergency situations and complications related to VAD	Control of complications and improved survival
A26³⁵35 Barbara DW, Wetzel DR, Pulido JN, Pershing BS, Park SJ, Stulak JM. The perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery. Mayo Clin Proc [Internet]. 2013 [cited 2016 Aug 12]; 88(7):674-82. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070328/pdf/ACA-19-676.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Mayo Clinic Proc/ 2013	Retrospective	V	Management of patients with VAD in the perioperative period	-	-
A27³⁶36 O'Shea G, Teuteberg JJ, Severyn DA. Monitoring patients with continuous-flow ventricular assist devices outside of the intensive care unit: novel challenges to bedside nursing. Prog Transpl [Internet]. 2013 [cited 2016 Aug 16]; 23:39-46. Available from: http://journals.sagepub.com/doi/abs/10.7182/pit2013494 http://journals.sagepub.com/doi/abs/10.7...	Prog Transpl/ 2013	Review	V	Expansion of scientific knowledge about the use of VAD: components, associated benefits and complications	Assessment and management of health problems: interpretation/request for laboratory tests and other diagnostic procedures; realization of physical examination; monitoring vital signs; patient admissions and discharges; home visits	Patient monitoring to prevent or diagnose early complications associated with the use of the VAD
A28³⁷37 Ballew CC, Surratt JF, Collins TL, Shah N. Gastrointestinal bleeding in patients with ventricular assist devices: what every cardiac nurse should know. Prog Transpl [Internet]. 2013 [cited 2016 Aug 13]; 23:229-34. Available from: http://journals.sagepub.com/doi/pdf/10.7182/pit2013954 http://journals.sagepub.com/doi/pdf/10.7...	Prog Transpl/ 2013	Review	V	Complications: intestinal bleeding	-	-
A29³⁸38 Song Z, Gu K, Gao B, Wan F, Chang Y, Zeng Y. Hemodynamic effects of various support modes of continuous flow LVADs on the cardiovascular system: a numerical study. Med Sci Monit [Internet]. 2014 [cited 2016 Aug 14]; 20:733-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020910/pdf/medscimonit-20-733.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Med Sci Monit/2014	Case-control study	IV	Benefits: hemodynamic effects	-	-
A30³⁹39 Naik A, Akhter SA, Fedson S, Jeevanandam V, Rich JD, Koyner JL. Acute kidney injury and following ventricular assist device implantation. Am J Nephrol [Internet]. 2014 [cited 2016 Aug 9]; 39(3):195-203. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000722/pdf/nihms559256.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	Am J Nephrol /2014	Retrospective	V	Complications: kidney damage	-	-
A31⁴⁰40 Prichard RA, Juul M, Gazibarich G, Davidson PM, Mason C, Keogh AM, et al. Six-minute walk distance predicts VO2(max) in patients supported with continuous flow left ventricular assist devices. Int J Artif Organs [Internet]. 2014 [cited 2016 Aug 15]; 37(7):539-45. Available from: http://www.artificial-organs.com/article/six-minute-walk-distance-predicts-vo2--max--in-patients-supported-with-continuous-flow-left-ventricular-assist-devices http://www.artificial-organs.com/article...	Int J Artif Organs/ 2014	Exploratory and descriptive	V	Nurses health care practice in caring for the patient with VAD	Assessment and management of health problems: interpretation/request for laboratory tests and other diagnostic procedures; realization of physical examination; monitoring vital signs; patient admissions and discharges; home visit	Patient monitoring to prevent or diagnose early complications associated with the use of VAD
A32⁴¹41 Lee GY, Park S, Kim S, Choi N, Jeong DS, Jeon E, et al. The successful implantation of continuous-flow left ventricular assist device as a destination therapy in Korea: echocardiographic assessment. J Korean Med Sci [Internet]. 2014 [cited 2016 Aug 14]; 29:137-40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890465/pdf/jkms-29-137.pdf https://www.ncbi.nlm.nih.gov/pmc/article...	J Korean Med Sci /2014	Case study	IV	Benefits: cardiac rehabilitation	-	-
A33⁴²42 Marcuccilli L, Casida JJ, Bakas T, Pagani FD. Family caregivers' inside perspectives: caring for an adult with a left ventricular assist device as a destination therapy. Prog Transpl [Internet]. 2014 [cited 2016 Aug 13]; 24:332-40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25488555 https://www.ncbi.nlm.nih.gov/pubmed/2548...	Prog Transpl /2014	Hermeneutic phenomenology	V	Perception of caregivers of adults with VAD	Evaluating the perception of patients, family members, caregivers and nurses	Possibility of interventions based on the actual situation
A34⁴³43 Biselli B, Ayub-Ferreira SM, Avila MS, Gaiotto FA, Jatene FB, Bocchi EA. Dispositivo de assistência ventricular esquerda seguido de transplante cardíaco. Arq Bras Cardiol [Internet]. 2015 [cited 2016 Aug 15]; 104(3):e22-e24. Available from: http://www.scielo.br/pdf/abc/v104n3/pt_0066-782X-abc-104-03-0e22.pdf http://www.scielo.br/pdf/abc/v104n3/pt_0...	Arqu Bras Cardiol/2015	Case study	IV	VAD implant for heart transplantation	-	-

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[1] Correspondence: Virna Ribeiro Feitosa Cestari. Rua Rafael Carlos Medeiros, 240, Bairro Tamatanduba, 61760-000 - Eusébio, Ceará, Brasil. E-mail: virna.ribeiro@hotmail.com