LVAD (Left Ventricular Assist Device) Home Health Care Protocol

My Home Nurses || NM
Clinical Intervention & Patient Teaching Guide

Reviewed and approved 06/30/2026
Annie Tchinjo RN, MSN  |  Terri Lorenz, RN  |  Felix Leshey MRes

CRITICAL PROGRAM ADVISORY: This template provides a standardized mechanism for tracking clinical metrics, implementing meticulous driveline wound care, managing systemic anticoagulation, and educating patients on equipment troubleshooting. For immediate technical or equipment emergencies, call the VAD Implant Center at 312-926-1711.

1. MANDATORY PROGRAM CONSULTATION STANDARDS

• Within 24 Hours of Admission: Cardiology consult, Transitional Care consultation (e.g., ANP or PA), Social Services consultation, and Dietary referral.
• Within 24-48 Hours of Admission: Pharmacy consultation for comprehensive Interim Medication Management Regimen reconciliation.

2. CARDIOVASCULAR ASSESSMENT & NOTIFICATION THRESHOLDS

• Vital Signs: Measure every 4 hours during the first 72 hours post-discharge, and once every shift thereafter, unless specified otherwise. Perform cardiopulmonary assessment every 8 hours.
• Immediate Notification Thresholds: Notify the provider if: Oral Temp > 100.0°F (37.8°C); Doppler MAP < 60 or > 90 mmHg; Respiratory Rate > 23/min; Heart Rate < 55 or > 110 bpm; or O2 Sat < 90%.
• Routine Echocardiography: Educate the patient on the necessity of routine echocardiograms to track RV function, cannula positioning, and device effectiveness, which provide the basis for pump speed adjustments.

3. METICULOUS DRIVELINE EXIT SITE & WOUND CARE

• Cleansing: Cleanse using 1% Chlorhexidine or an order-specified combination of chlorhexidine and sterile saline.
• Dressing: Cover with a sterile 4×4 gauze dressing; ensure the dressing is completely occlusive at all times.
• Securement: Always use abdominal binders, anchor patches, or structural stabilization devices to prevent traction or manipulation. Never place mechanical stress on the line.

4. ANTICOAGULATION MANAGEMENT

• Laboratory Frequency: Weekly BMP, CBC, and PT/INR, unless otherwise ordered.
• Targets: The standard institutional INR target is 2.0 to 3.0, though levels are individualized based on patient history and specific device model.

5. COMPLICATION ASSESSMENT & EMERGENCY PROTOCOLS

• Neurological Screening: Screen daily for mentation changes, confusion, headache, numbness, or focal weakness.
• Hemorrhage: Report signs of overt bleeding (melena, hematuria, hematemesis) or unmanageable epistaxis.
• Equipment: Verify backup battery pairs, primary system consoles, and mobile monitoring software. In event of malfunction, contact the VAD Implant Center at 312-926-1711.

6. STERNAL PRECAUTIONS & REHABILITATION

• Sternal Precautions: Maintain rigid, non-negotiable sternal restrictions for at least 6 weeks post-implantation.
• Mobility: Progress activity safely according to the multidisciplinary rehabilitation plan.

7. HOME HEALTH CLINICAL VISIT NOTE INSERT

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MHN/NM HOME HEALTH - DAILY LVAD VISIT NOTE
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[ ] CONSULTATIONS (<24-48h): Cardiology [ ] | Transitional Care [ ] 
    | Social Work [ ] | Dietary [ ] | Pharmacy [ ]
[ ] VITALS & NOTIFICATION (Notify if out-of-bounds):
    - Temp: ____°F (>100.0) | MAP: ____ mmHg (<60 or >90) 
    - HR: ____ bpm (<55 or >110) | RR: ____/min (>23) | O2 Sat: ____% (<90)
    - 8hr Cardio assessment [ ] | ECG monitor checked [ ]
[ ] DRIVELINE WOUND CARE:
    - Dressing 100% occlusive [ ] | Cleansed w/ 1% Chlorhexidine [ ]
    - Evaluated site (no drainage/erythema/pain) [ ]
    - Securement (binder/anchor) in place [ ]
[ ] ANTICOAGULATION/LABS:
    - Weekly bloods done [ ] | Today's INR: ____ (Goal: 2.0-3.0)
    - Screened for bleeding (melena/hematuria/epistaxis) [ ]
[ ] EMERGENCY/TROUBLESHOOTING:
    - Neuro screen normal [ ] | Controller [ ] NO Alarms [ ] YELLOW [ ] RED
    - Backup gear validated [ ] | VAD emergency line 312-926-1711 [ ]
[ ] REHAB: Sternal precautions 6wks [ ] | Sterile technique demo [ ]
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