Post-Operative Stay in the Hospital
Upon arrival to the ICU, you will receive close monitoring and support. You will have a breathing tube, drainage tubes (chest tubes), and a catheter in your bladder. You will receive medications for sedation and pain control. You will also be on intravenous (IV) medications until your blood pressure is stable. Your length of stay in the ICU will depend on how fast you recover. Once you are breathing on your own and more stable, you will be transferred to a general care unit where you can expect to stay for another 1-3 weeks. On average, patients spend about three weeks in the hospital after the VAD surgery, but this can vary depending on how sick you were before the surgery and if there are any complications after the surgery. Most patients can return home after VAD surgery. You will need additional rehabilitation and recovery at an inpatient rehabilitation facility.
Daily you will be followed by the medical team, including your surgeon, your cardiologist, VAD coordinators, nurses, nurse practitioners, physician assistants, pharmacists, physical/occupational therapists, and social workers. They will monitor your recovery and help you adjust to life with your VAD. Soon after your surgery, it will be very important to begin preparing to go home. You will have to be both physically strong and able to care for your VAD to be discharged from the hospital. Most patients return home, but some patients choose to live with a caregiver or need a rehabilitation facility for a short time before returning home. If necessary, a home health nurse may come to your home for a few hours a week to help with your care.
Going Home with a VAD
During the time in the hospital after surgery, it is expected that you, your caregiver, and your family will learn how to take care of you and the VAD at home. You and your caregiver(s) will be trained by a VAD coordinator to take care of your VAD. Other staff, such as your bedside nurse, occupational and physical therapists, and cardiac rehabilitation therapists will also provide training.
You and your caregiver(s) must be able to manage the VAD, understand how it works, troubleshoot problems, and care for your driveline exit site. Your driveline will require special care. You and/or your caregiver will be taught the process for sterile dressing changes while in the hospital. Sterile dressing changes to the VAD exit site will be a lifetime requirement.
The caregiver has to be present and available at the hospital to learn the care instructions for the VAD. This education will be ongoing while you are in hospital. Before going home, you need to ensure consistent electricity and phone services as a prerequisite. VAD requires significant self-care responsibility and a willingness to participate with your VAD team. You must keep the team informed regarding your contact information and address.
After you are discharged, you will follow up in the clinic with your medical team. They will work together to care for you and make decisions about your treatment. Typically, your first visit will be every alternate day for the first week after discharge. As your health improves, visits may be further apart. Once you are considered stable, your doctors may decide that you can follow-up every 2-3 months. Along with seeing a cardiologist for your heart failure, you will need tests regularly to monitor and maintain your health. The types of testing that you may need will be decided by you’re the medical team but the most common tests include blood tests, electrocardiogram (EKGs), echocardiogram (ECG), an implantable cardioverter-defibrillator (ICD) checks.
On average, about 8-12 weeks after surgery you can expect to be able to do most activities, with the permission of your doctors.
AT HOME TRAINING FOR PATIENT AND CAREGIVER
Our medical team focuses on three fundamental things while training the patient and caregiver.
- Care of the Driveline
- Blood pressure control and monitoring
- Anticoagulation and anti-platelet management - Patients who have a VAD need to take anticoagulation medications (blood thinners such as warfarin/coumadin) which require regular monitoring with blood tests.
You will also be in frequent contact with a VAD coordinator who will make phone calls to see how you are doing at home and assist you with any problems. At the KIMS Heart and Lung Transplant Institute, the VAD coordinator is available 24 hours a day for any questions or emergencies.
Care for the Device and Connected Equipment
Along with the VAD that is implanted inside your body, you will have several other external pieces of equipment that will require care and maintenance. You will have a driveline that exits your body through your abdomen which is attached to a controller (computer) that runs the heart pump. The controller will sound an alarm if there are any problems with the pump or the controller itself. To power the VAD and the controller, you will have batteries, a battery charger, and an electric (AC) power device. The batteries allow you to move around freely without being attached to outlet power. The battery charger allows you to re-charge your batteries when needed. And the AC power device allows you to be connected to electric (wall) power for long periods such as when you are sleeping. The equipment will be specific to your type of VAD.