Panel Discussion 3

Role of a Clinical Engineer in the Treatment of Patients with Acute-cardiac

FailureKYOICHI KENMOKUSchool of Biomedical Engineering, Faculty of Health and Medical Care, SaitamaMedical University

When a patient with acute-cardiac failure shows no sign toward recovery by medical

treatment, mechanical circulatory support with IABP, PCPS, or VAS, is needed.

The most important role of clinical engineer is maintain these circulatory assist de-

vices always in best condition enable to be available in the suitable timing.

The major important points in management of theses devices.

1. Selection of assist device to obtain most effective circulatory support.

2. Initiation of mechanical support before multiple organ failure occurs.

3. If the effect is inadequate, more powerful mechanical assist device is needed.

The following items are also important in the management of patients and successful

results.

1. Maintenance of systemic circulation

2. Urine output

3. Ventilation

4. Anticoagulant therapy

S154 Journal of Cardiac Failure Vol. 12 No. 8 Suppl. 2006

Panel Discussion 3

Clinical Pathway for the Management of Acute Heart Failure; Present and

FutureTAKASHI HONDA, KOICHI NAKAO, TAEKO MURAMOTO, MIYUKI KUZE,SACHIKO HORIKAWA, KUMIKO HAYASHI, YASUHIRO KAWANAMIDepartment of Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto,Japan

In 2005, we admitted 297 emergency cases of acute heart failure in our CCU. Upon

their arrival, a team of allied health professionals activate protocols for survival under

the medical supervision; they examine vital signs, deliver oxygen, sample blood, es-

tablish venous line, place ECG monitor, infusion pumps and introduce mechanical

ventilation, IABP, PCPS, or blood purification therapy. In our CCU, physicians

and nurses are primarily in charge, assisted by full-time clinical engineers (CE).

These patients often require respiratory support and CEs are set values of ventilators

and assist physicians during weaning. They also monitor pressure during Swan-Ganz

catheterization, set up and service monitors, and manage IABP and blood purification

systems. They constantly monitor patient hemodynamics as nurses do. Case manage-

ment based on clinical pathway is practiced for some time in our center. With acute

heart failure, however, due to advanced age and diversity of complications and sever-

ity, when mechanical ventilation or IABP is required, the clinical course becomes so

diverse and application of clinical pathway is limited to a subset of patients. On the

other hand, different subspecialties and consultation services are involved in the care

of acute heart failure, at admission, discharge preparation and rehabilitation. That is

exactly when a team approach guided by clinical pathway can excel in quality of care

by standardizing services and securing patient safety.

Panel Discussion 3

Co-medical Role in the Management of Acute Heart Failure and its DevelopmentAKI UEYAMANursing Department of Kitasato University Hospital, kanagawa, Japan

Patients in the intensive care unit (ICU) always receive treatment and nursing care

based on the data obtained from the latest monitoring equipment. Nursing care, at

times, requires that rapid and appropriate measures be taken for initial symptoms

and abnormalities caused by acute heart failure. Medical equipment is useful to ob-

tain the necessary information from the patient as quickly as possible, however num-

ber and type of machines have increased around the patient year by year which have

many complicated functions. To interpret the complex monitoring data obtained from

the equipment requires that the nursing staff understand the basic information pro-

vided. Nursing care in the ICU not only includes interpreting monitoring data and

judging what emergency measures should be taken, but also understanding and man-

aging the equipment. Appropriate nursing care using the equipment leads to suitable

treatment and the opportunity to reduce the term of hospital admission for the patient.

To offer high quality nursing, it is especially important to collaborate with the med-

ical engineer, pharmacist, dietetician, medical doctor and the other co-medical stuff.

In this session, we are going to discuss about the future of nursing care in the ICU

concerning points of the current monitoring equipment and term of hospital admis-

sion by comparing these with those ten years ago.

Panel Discussion 3

Roles of Nurses in the Care of Acute Heart FailureAIKO KITAMURADepartment of Nursing, Rinku General Medical Center

The incidence of acute heart failure rises with age. Cardiogenic shock, pulmonary

edema, and acute exacerbation of chronic heart failure can threaten the lives of pa-

tients. Nurses are expected to provide care based on understanding of the conditions

underlying acute heart failure. When providing care to such patients, emphasis is laid

on circulatory care, respiratory management, regulation of tissue oxygen metabolism,

and mental support. Meanwhile, ethical aspects are reviewed and dealt with appropri-

ately by the medical team. Nurses are required to act promptly and work with many

other specialists while being aware of the fact that the patient is hovering between life

and death.

During this session, I will discuss the characteristics of patients and their families,

citing cases where a circulatory assist system was used to deal with acute heart fail-

ure. Roles of nurses in the care of such patients will be discussed on the basis of my

experience with major nursing intervention. I will also refer to the roles of nurses in

introducing noninvasive positive pressure ventilation (NPPV) at our facility. (Consent

has been obtained from the patients for the use of their data in this presentation for

promoting advances in critical nursing care.)