Optimizing Physical Cond Prior to Heart Transplant. in Pts on Centrimag Bi-VADThrough Prog Ambulation Nrsg Initiatives

Purpose:
External Bi-VADS are used to treat patients requiring temporary left and/or right side ventricular support.Early mobilization of Pts requiring external circulatory support is difficult. Our goal was to create a safe approach to early mobilization for this population optimizing them for transplant.

Significance:
Internal decannulation from the anastomosis sites, as well as separation of the circuit tubing can result in massive blood loss, air embolism and death. The external components of the system are heavy and often difficult to maneuver, requiring a team of staff to mobilize the patients.

Strategy and Implementation:
A multidisciplinary team was involved, including nursing, physical therapy, providers, perfusionists, the patient and the patient's family. A checklist was created which included the necessary safety checks to perform prior to ambulation and individuals who would need to be involved in the ambulation process. This list also includes a review of emergency management procedures should one of the aforementioned situations arise. Additionally instructions were created for the bedside nurse explaining the proper way to transfer the patient to the bedside chair and back. The initial patient that this process was created for, as well as his family, was directly involved in the creation of both the ambulation checklist as well as the patient transfer discussions, achieving the nursing goal of Relationship Based Care.

Evaluation:
Zero events of harm during all ambulation sessions. Success measured through increased family participation in patient care, increased patient engagement and increased trust between patient/family and team. Increasing walking distances during physical therapy sessions without need for rest.

Implications for Practice:
We have implemented these tools in the care plans for all of our Centrimag patients with non-femoral cannulation sites. The development of these standardized processes improved nursing confidence that ambulating these patients could be done safely. Improved physical readiness for heart transplant.