Left Ventricular Assist Device

dallend@einstein.edudallend@einstein.edu
in CDI Talk Archive
I currently am reviewing a chart for a pt admitted with chest pain. Pt also has a LVAD. Cause of chest pain at this time in uncertain. MDs are evaluating the LVAD though. Pt is on anticoagulant therapy. I had to query for type of CHF for the patient. Has anyone ever come upon this device in their chart reviews? Is there anything specific to this device that I should be looking for? I know I can look for possible upgrades to the device, complication code related to the device. I just don't want to miss anything.
Thanks,
Debby Dallen,RN
Clinical Documentation Coordinator
Albert Einstein Medical Center
Phila PA 19141

Comments

  • susan_ritzenthalersusan_ritzenthaler
    edited May 2016
    Debbie- our hospital is a transplant hospital that also has large population with LVADS- I always query for cardiogenic shock with LVAD because without the Pumping of the LVAD the patient would expire. They should also have Chronic systolic heart failure- sometimes acute blood loss anemia or GI bleed r/t to LVAD. Thanks Sue


  • dogdog
    Occasionally our cardiologist will use a Tandem heart, a type of LVAD, during a cath lab case and then it is taken out before the end of the case by the surgeons.

    I certainly agree that there is likely heart failure to be queried, but I would think twice about automatically asking for cardiogenic shock. LVADs can be used in patients who are not in cardiogenic shock, and without clinical indicators to support the diagnosis, I might be fishing.

    Actually, my biggest challenge in a Tandem heart case was convincing our CFO that it fell into DRG 216-218; our cardiologist was sure it was a higher reimbursement...but it isn't.
  • susan_ritzenthalersusan_ritzenthaler
    edited May 2016
    In our institution the LVADS are used for destination therapy (usually about 2 yrs) or bridge to transplant. Their at end stage heart failure, have had an unfortunate major chest injury, or some form of cardiomyopathy causing severe heart failure symptoms (ie pregnancy). If the LVAD were turned off on these patients they would die. Cardio thoracic society definition of cardiogenic shock is BP 90. CI 18 and requiring mechanical or rxt. Patients with a LVAD in the above situations have low CI and require mechanical treatment.

    Our doc's chart cardiomyopathy with acute on chronic (or just chronic) systolic heart failure, cardiogenic shock with support from LVAD.

    I would have difficulty querying for cardiogenic shock in a procedure where LVAD were used temporarily also.

    I think of these patients with cardiogenic shock and LVADS like someone who is ventilator dependant in chronic respiratory failure- they would continue to be in respiratory failure and we wouldn't turn off the vent to prove it. As with the LVAD population we wouldn't turn off the LVAD to see if they are still in cardiogenic shock.

    I also find they come in septic with drive line infections. At times develop bleeding, and are chronically anemic. This population become frequent flyers to the hospital system but their quality of life improves with the LVAD for the majority.




  • dogdog
    I guess we will have to agree to disagree. I just can't see cardiogenic shock as a chronic condition. End stage heart failure, yes, but not cardiogenic shock. I have never seen a clinical reference to any kind of shock as a chronic condition, and I would not query for it if someone had a intervention two years ago which stabilized their cardiogenic shock.

    But that's what I love about this group; we have so many different experiences and perspectives to share. :)

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
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