Table 4.

Challenges faced by the nephrologist and dialysis nurses in the hemodialysis unit and with left ventricular assist devices

Volume status
 Numbers 1–3 appear on the LVAD screen
 (1) Pump speed: rate of revolution of rotor
  Higher speed leads to higher flow, usually 3–10 L/min
 (2) Pump flow rate: derived from pressure differential across pump
 (3) Pulsatility index: related to native ventricular pulsatility
  When preload decreases then pulsatility index decreases
  Low pulsatility index can indicate excessive ultrafiltration
BP measurement
 Use a Doppler audible ultrasound with calibrated BP device
 Place Doppler probe over brachial artery and inflate cuff
 Listen for flow as cuff is deflated to get the mean arterial pressure
 Ideal mean arterial pressure is 70–80 mm Hg, and should not exceed 90 mm Hg