Role of nurses in domiciliary treatment for patient with implantable left ventricular assist device

[Backgrounds]Treatment for end-stage heart failure has been shifting from inpatient care to domiciliary treatment according to the commence of health insurance reimbursement for implantable left ventricular assist device (LVAD). Majority of patients with LVAD treatment are able to enjoy better quality of life and rehabilitation in society, which was not achievable with conventional medical treatment. [Current status and management] We established the ventricular assist device center at Tohoku University Hospital in April, 2013, and have dedicated ourselves to manage domiciliary treatment for patients with LVAD. There have been currently three so-called LVAD nurses belonging to the VAD center, and all are qualified with a certificate for LVAD specialist. The LVAD nurses play a role as a contact person and a coordinator for outpatient clinic for patients and their family including emergent occasion. They are also in charge of home anti-coagulant management utilizing a coagucheck XS○R personal. Infection control of drive-line exit site is another area of important management by them. When infection is suspected, the patients are required to send them some photographs of the exit site which are then meticulously assessed along with the updated information on each patient obtained over the phone. Selected surgical dressings and instruction on sterilization technique for patients are also provided by the LVAD nurses. [Summary] The number of patients requiring LVAD treatment has been increasing and the number of available devices has also been expanding over the last three years. Accordingly, medical professionals are requested to provide individualized care and management for each patient. The VAD center has undoubtedly played a central role to enable the patients with LVAD to live their lives at home by a team effort with integrated knowledge and expertise shared among LVAD specialists.