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CAPC Palliative Care Discussion Forum
Palliative Care Out-Patient Services
LVAD as destination therapy and Palliative CareAuthor: mmschepp
Date: May 6, 2010 10:24 am
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| Re:LVAD as destination therapy and Palliative Care (by Deb on 05/06/2010)
I used to be an LVAD nurse in my former life. My experience with them now is rare. That is in large part due to the fact that the main surgeon does not buy into palliative care. He has let me be involved only in cases that are truely EOL, and even then it is usually the cardiologist or LVAD coordinator that push getting me involved. My experience with the pts themselves is that they are typically the type that are wanting aggressive treatments to prolong their lives, but do have pain and symptom management needs. Of course the surgeon and cardiology think they are managing those just fine thank you. So, I really only get involved when they are actively dying, or the team thinks they have reached the point of futility and then ask me to assist with moving the family towards withdrawal. These can tend to be challenging because they are the pt/families seeking to prolong their lives as long as possible. Also, we have had issues with LVAD pt's and hospice (hospice would not accept them because they were not trained on the pump, even though the family is), so they have ended up staying inhouse. I think we are working on training the hospice which is within our system because as the LVAD population grows, so does the need for hospice care. I have spoken to the coordinator about doing more education up front about how the LVAD will effect QOL, but with some pt's, once they hear there is a way to prolong their life, they don't hear anything else. I have found that with the transplant population as well. They conveniently "forget" what they were taught about lifelong meds and medical needs unitl they are there and decide "no one told me it would be like this."Hopefully you have a surgeon and cardiology team who will let you be involved at the start to assist with decision making. That would be my goal. You are there for pain and symptom management, and they already know you when the driveline gets infected, or they have a CVA, etc...
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| Re:LVAD as destination therapy and Palliative Care (by SharolHerr on 05/11/2010)
I understand some hospital based Palliative Care Programs are placing some of their consult team in "Heart Hopsital" settings. In Columbus, that would be Ohio State University. I haven't talked with them specifically about involvement with the LVAD population but you may explore this with someone from their team. Sharol Herr, RN, BSN, MSEd, CHPN; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
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