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The Very Critical, Vastly Chaotic, Vital and Changing VAD Coordinator

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Dawn Christensen, MS, CRNP
Innovative Program SOlutions
Pine Grove, PA, USA

What exactly is a VAD coordinator? What do they actually do? Why do we need VAD Coordinators? ICCAC what?

Those of us who work in VAD programs know that the presence of a VAD coordinator is crucial to the success of a program. The Joint Commission requires that all certified VAD centers have one. So why have we had such a hard time trying to explain what a VAD coordinator is and does? Why has it been so hard to identify the core knowledge necessary to perform the role? Let's start at the beginning.

The origin of the VAD coordinator role came in the early 1990's when VAD's left the lab and became an option as therapy for end stage heart failure. As the field began to develop, it quickly became apparent that there was a growing gap between the medical and technical aspects of caring for this new kind of patient. There needed to be someone to bridge those worlds and integrate them first into the inpatient world and later into the community.

VAD coordinators came from, and today still do come from, many different backgrounds. The role was filled by research coordinators, biomedical engineers, perfusionists, lab techs, physicians and nurses, as well as other backgrounds. As the population and number of implanting centers grew, many centers looked to nursing personnel to fill the gap.

There were no job descriptions, defined responsibilities, or orientation into the position, and very few opportunities for mentoring. Training to manage all aspects of the devices was provided by the manufacturers and often was limited to initial in-person presentations to a core team. Follow up education was very limited, and VAD coordinators assumed responsibility for orienting all personnel involved with VAD patients. Daily tasks included creative interventions as we gained experience using the technology. Coordinators had to be proficient in a technical as well as medical field and be able to blend the two with very little direction. The terms "jack of all trades" and "MacGyver" summed up what was and is still necessary to perform this role.

Some of my favorite memories of creative interventions include taking apart a Thoratec Dual Drive Console (DDC) and reseating computer cards that had come loose during movement of the device; patching a Thoratec PVAD pump that had cracked and was leaking air after the patient fell (Thankfully, I had the pleasure of working with and being able to fall back on some amazing artificial organs engineers and some really cool putty they brought with them to seal the leak); learning how to drive the hospital mini bus so the HeartMate Implantable Pneumatic (IP) device patients could get out of the hospital for a few hours to go to a hockey and baseball game (not to mention making all of the arrangements to do it safely); identifying and troubleshooting medical issues with patients from the ICU through outpatient clinic and deciding whether the issues were pump related or not.

On a personal level I remember thanking the universe for extensive ICU training as a nurse as well as family practice nurse practitioner training. When caring daily for the 80 year old destination therapy (DT) patient with an elevated PSA and the 14 year old bridge to transplant patient with recurrent VT; calculating dosages of amiodarone, sedation and cardioversion of that 14 yo all while mediating the intense "discussion" between the pediatric cardiologist with no VAD experience and adult cardiologist with lots of VAD experience who disagreed on the correct course of treatment that should be taken (I'll let you use your imaginations to figure out who won that one). And the stories could go on and on.

The technology has evolved and with it so has the role. The International Consortium of Circulatory Assist Clinicians (ICCAC) was created in 2007 to help establish a community for those caring for VAD supported patients. Its members include adult and pediatric VAD coordinators as well as anyone who cares for MCS patients. Its mission is to be able to provide a network, to ask questions, find a mentor, or discuss issues with others in the field. A wealth of information and experience has been compiled and discussions held on the MCS Collaboration online discussion board. It has helped to connect more experienced coordinators with those who are looking for help or suggestions. More importantly it has helped to connect coordinators so that a more consistent role definition could be developed.

The MCS world has evolved from a limited number of implant centers, all of which were academic cardiac transplant centers. There was a limited population of patients that were all hospital bound. We now have an increasing number of community implant centers with an ever increasing collection of patients in many, and sometimes distant, communities. Daily tasks may have changed but the need for VAD coordinators continues to be essential to successful programs. The overriding theme of the position continues to have at its core bridging the gap between the technical and medical worlds as well as regulatory and administrative worlds within an implant center.

With that in mind I would like to leave you with a job description that was created in the late 1990's as a parody for the coordinators at that time. It is still relevant today and sums up the role in many ways.

Job description of a VAD Coordinator:

Detail oriented practitioner with the ability to multitask, critically think, prioritize, and is well versed in crisis management. Able to independently manage patients with complex medical conditions as well as perform administrative and investigational tasks simultaneously. Willing to work at least 60 hours per week and remain on call and accessible at all times. Willing to work in high tech, intense field, while frequently making peace amongst members of the team. Possesses the ability to be gracefully overruled despite being made responsible for aforementioned anticipated problems. Able to do large amounts of paperwork while remaining calm in situations that are not familiar and for which training is not provided. Able to deal with other "professionals" from all parts of the medical field while being asked to justify existence to administrators who have no idea as to what it is that the position entails. Experience in creatively "appropriating" supplies and equipment while magically producing monetary funds as well as patient support systems is desired. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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