The Thoratec ventricular assist device (VAD) offers a final hope for survival in patients with severe cardiogenic shock unresponsive to conventional therapy. In select patients, these pneumatically activated prosthetic ventricles maintain organ perfusion pending recovery of the native heart or cardiac transplant. A detailed review of Thoratec VAD operation, its impact on the circulatory pathway and hemodynamic monitoring, and troubleshooting guidelines specific to these patients are presented. A nursing diagnosis framework assists with the identification and management of problems such as impaired cardiac output and gas exchange, as well as altered mobility, nutrition, and coping. Current information regarding the etiology and management of complications such as bleeding, infection, and end-organ failure are reviewed. A case study presentation offers guidelines for weaning patients from the VAD and includes a comprehensive nursing care plan for these challenging patients

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