The challenges of providing anesthesia for patients with Left Ventricular Assist Devices (LVADs) can only be fully appreciated with a discussion of just how significantly their physiology differs from the norm. First, many patients with LVADs will have either a very weak or nonexistent pulse, which decreases the functionality and accuracy of noninvasive monitoring modalities that rely on pulsatility to generate information. When auscultating LVAD patients, the provider will not hear heart tones, but rather, a “hum”. The continuous flow through the pump is what causes the “humming” sound and is also the culprit behind the lack of native pulsatility. These patients must be on chronic anticoagulation to prevent pump thrombosis. This, in addition to the acquired coagulopathy caused by the shearing of erythrocytes and platelets by the centrifugal pump, significantly increases bleeding tendency. Anticoagulation must be carefully balanced to avoid both hemorrhage and thrombosis. Finally, patients with LVADs are considered preload dependent and afterload sensitive. They require enough fluid resuscitation to maintain forward flow without precipitating acute congestive heart failure and pulmonary edema. 

Learning Outcome(s):

1. Evaluate the unique physiological considerations and anesthetic management techniques required for patients with Left Ventricular Assist Devices (LVADs) undergoing surgery.  
2. Analyze the effectiveness of active learning techniques, such as test-enhanced learning and spaced repetition, in improving anesthesia providers' retention of knowledge regarding LVAD management.

This program has been prior approved by the American Association of Nurse Anesthesiology for 1.00 Class A CE credits; Code Number 1045290; Expiration Date 2/12/2028.

Accreditation Information:
The American Association of Nurse Anesthesiology is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. 

AANA is an approved provider by the California Board of Registered Nursing, CEP #10862.

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Post-Test Attempt Notice:
A minimum passing score of 80% is required to pass this course. You have TWO opportunities to achieve a passing score. If you fail to achieve a passing score of 80%, you will not receive CE credit for this course.

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Refund Policy:
Continuing education activities are nonrefundable.