Update on ventricular assist device technology.

Ventricular assist devices are an important component in the arsenal of therapies to support the failing heart. This article provides an update on the variety of pulsatile, centrifugal, and axial-flow devices available in the United States. Common indications such as Bridge to Recovery and Bridge to Transplant are explored, as are the emerging indications Destination Therapy, Bridge to Decision, and Bridge to Bridge. Ventricular assist devices as support during high-risk percutaneous coronary intervention and the devices that can be rapidly deployed for this support are included. Clinical aspects of patient care including common complications, psychosocial concerns, and ethical considerations are reviewed.

Ventricular assist devices in the adult.

Ventricular assist devices (VADs) play an increasingly important role in the care of cardiovascular patients. Developed initially for support of cardiothoracic surgery patients experiencing difficulty in weaning from cardiopulmonary bypass, these devices have been used extensively as a bridge to cardiac transplantation for patients who are failing on medical management. Research has demonstrated the effectiveness of a VAD as destination therapy, providing a permanent means of support for patients with advanced heart failure who are not eligible for heart transplantation. Applications for VADs are expanding and advances in technology occurring to support these new applications. This article provides an overview of current and emerging VADs and nursing management of the VAD patient.

An upstream approach to selecting progressive care technology.

A systematic approach to evaluating progressive care technology needs and options helps you purchase items that meet patient needs and enhance the provision of care facility-wide.

The advanced practice nursing role with multisite responsibilities.

A multisite APN role presents a unique perspective. You may see this in terms of opportunities or as frustrations. Ultimately it is your response, not the situation, that determines the outcome. As with any major transition, it can be a catalyst to transform yourself and reenergize your practice. Careful attention to the elements presented here can give you a good start. From there, adaptability is the key, as Lao-tzu said "a good traveler has no fixed plans and is not intent upon arriving. A good artist lets his intuition lead him wherever it wants. A good scientist has freed himself of concepts and keeps his mind open to what is."

Ventricular assist devices: developing and maintaining a training and competency program.

Ventricular assist devices (VADs) have made it possible for patients with end-stage heart failure to survive until a donor heart is available. In addition to serving as a bridge to transplantation, evolving indications for VADs include bridge to recovery and destination therapy. There are many VAD programs, but in the majority of programs only a small number of devices are implanted each year. Low volume poses a challenge in terms of provision of comprehensive education and training for nurses who will care for patients with VADs and in terms of maintaining competency to care for these patients. This article briefly addresses current VAD technology and VAD program development. The major focus is on the education and competency challenges and solutions the authors have experienced as infrequent users of VAD technology.