Before, During, and After LVAD Implant: Caregiver Responsibilities

Before LVAD Implant

LVAD is a planned surgery, so you will have time to plan to prepare. Learn as much as you can about LVAD by:

• Meeting with other patients and caregivers at support groups
• Signing up for educational opportunities
• Reading about LVAD
• Talking with members of the LVAD team

Make sure you learn:

• What to expect during the surgery and recovery process
• How you will support the patient
• What type of device will the patient receive (model, equipment)
• The survival rates and what the patient’s life might be like after surgery
• The medical and psychological risks:
  • Blood clots
  • Bleeding
  • Infection
  • Right heart failure (an LVAD is on the left side of the heart)
  • Anxiety
  • Depression
  • Loss of sleep
  • Dependence on caregivers
  • Body image issues
  • Not being able to continue activities the patient enjoys
• How to prepare the patient’s home:
  • Make sure there are 3-prong outlets by the patient’s bed
  • Remove throw rugs

LVAD Surgery

The day before surgery the patient will prepare in the hospital or clinic.

• This could include a right heart catheterization (RHC)
• RHC is when a catheter in the patient’s neck or groin checks pressure and blood flow in the right side of the heart

The surgeon might tell you how long the LVAD surgery could take. 

• This is an estimate and can change
• Surgery can take longer for patients who have had other chest surgeries

After surgery, the patient:

• Will be closely monitored in the Intensive Care Unit (ICU)
• Might stay on oxygen, but the breathing tube will be removed 6-24 hours after surgery
• Will have tubes in their chest to remove extra fluid. (Tubes are removed before discharge)
• Will move from the ICU to a different hospital unit as they recover
• Might be discharged to an acute rehab unit, to build strength before going home

You should spend most of the day at the hospital. You will:

• Learn from staff during the patient’s hospitalization
• Complete required educational hours, so the patient can be discharged
•  Watch videos and do hands-on training to learn how to:
  • Change bandages
  • Care for the LVAD device (change batteries, etc)
  • Understand different alarm sounds

After LVAD Surgery

You must care for the patient 24/7 after LVAD surgery. Usually, patients need constant care for 6-12 weeks. Some patients need constant care for as long as they have the LVAD. 

You will:

• Change dressing (bandages)
• Help manage medications, including blood thinner injections
• Track the patient’s weight, temperature, and PT (prothrombin time)/INR (international normalized ratio)
  • A PT (or pro time test) tests a sample of blood to see how quickly the blood clots  
  • It monitors how well blood-thinning medicine like warfarin (Coumadin) is working
  • You might have a home PT/INR machine
• Help the patient follow LVAD nutrition instructions, like:
  • Limiting salt intake
  • Drinking enough fluid
  • Monitoring Vitamin K (which is important with medication to prevent blood clots)
• Record all LVAD alarms
• Meet frequently with the LVAD team to check the alarm history and change settings
• Check LVAD batteries to make sure they are charged overnight and before leaving the home
• Help with household chores
  • The patient will have lifting restrictions after surgery
  • Restrictions change as they get stronger, but they can never lift more than 50 pounds
• Remind the patient to do safety checks of LVAD equipment and follow equipment directions 
• Help the patient shower, making sure the driveline area (where the tube enters the skin) does not get wet. 
• Create an emergency plan in case you lose power.
  • Ask your transplant center if they tell the electric company the patient has an LVAD
  • Most companies prioritize LVAD patients when they restore power
  • LVAD patients always need access to electricity