Note the following on the existing VAD before scrubbing.

• Membrane up or Blood up?
• Inflow and outflow directions?
• Tubing Length – Measure tubing length including any connectors.  Ensure it’s long enough for further device change but short enough it doesn’t cause problems when walking.
• Connector sizes.
• Where to clamp, where to reattach
• Heparin bolus 20-50u/kg
• Drive-line change?

Instructions to scrub nurse – 2x 50ml with Luer lock, 3x 50ml with long necks, large bowl to deair. Dry gauze pieces. Zip tie cutter. Marking pen for measuring. Wound swabs for cleaning out. Defib pads from theatre.

Prepare patient – incopad under the field. Check again the correct VAD chamber to change.

Priming chamber

Scrub up to prepare the new VAD. Get all the kit out on a sterile field.

Connect inflow and outflow silastic tubing. Cut to size if necessary.

Connect the given small tubing to the driveline port and attach to an empty 50ml syringe (luer-lock). Withdraw all the air, thus withdrawing the diaphragm fully. Clamp the tubing to keep the diaphragm stretched.

Insert the given needle into the nipple of the chamber avoiding the diaphragm. The needle may be fully inserted to the hilt without injuring the diaphragm.

Fill a luer-lock 50ml syringe with warm saline gently, avoiding any bubbles.

Prime the chamber by injecting the saline through a 2-way tap/tubing into the needle and the chamber. Sit up the VAD so air escapes through the outlet valve – do this in a bowl. Twist the tap off when changing syringes or finished filling.

Once filled, look for air and squeeze it out through the valves, and clamp the tubing.

Chamber change

Prep the patient thoroughly up to the insertion point. Ensure other VAD can be seen under the clear plastic. And drape around it.

Compare the existing VAD to the prepared VAD to ensure correct direction and facing membranes.

Confirm site of clamp placement.

Ensure anaesthesia team ready for clamping. 

Reduce the flow on the other VAD by 50%. Switch off the VAD to be changed.

Can get ready just before clamping by scoring the tubing to remove it.

Clamp and start timer.

Cut out the tubing and remove. Be careful about spilling blood.

Fill the tubes continuously with dripped saline to connect back up.

Dry gauze and check.

Clamps off.

Aspirate with tubing to the nipple for any air.