October 1, 2006
Kim Shelton, RN, wears many hats. Although her job title "LVAD nurse coordinator" is simple enough, her role for the Department of Cardiothoracic Surgery at Barnes-Jewish Hospital and Washington University School of Medicine is much more complex.
Shelton, of Kirkwood, MO, works with patients before, during and after the implantation of a left ventricular assist device (LVAD). She assists in the operating room during the procedure to implant the device. She monitors the patient''s progress during hospitalization at Barnes-Jewish Hospital. Before discharge, she teaches them and their family members how to manage the device. After discharge, Shelton coordinates outpatient visits and follow-up lab work and monitors their progress.
Whatever role she is playing at a given time, Shelton always thinks of the patients first. "I''m available 24 hours a day, seven days a week," Shelton says with enthusiasm. "I expect to hear from patients."
Just ask 36-year-old Michelle McMackin. In November 2003, Nader Moazami, MD, a Washington University cardiothoracic surgeon at Barnes-Jewish Hospital, implanted the HeartMate XVE Left Ventricular Assist System into McMackin.
"There''s not a situation that has come up that she hasn''t called me right back," said McMackin. "I have paged her for many different things, and no matter where she is or what time of day it is, she calls me right back."
McMackin''s heart problems first began after being diagnosed with bacterial endocarditis. She subsequently developed aortic insufficiency and mitral valve regurgitation requiring both valves to be replaced in February of 2003 at Barnes-Jewish Hospital.
By May, 2003, McMackin was readmitted to the hospital with symptoms of congestive heart failure. Further testing indicated that McMackin''s heart muscle was severely weakened. She was placed on the waiting list for heart transplantation. Unfortunately, her clinical condition continued to deteriorate. Dr. Moazami and the Heart Failure team determined that the an LVAD was the most viable treatment option to provide hemodynamic stability and preserve end-organ function until a suitable donor organ could be found.
Since leaving the hospital and eventually returning to her home in Sikeston, MO, which is about 150 miles south of St. Louis, Shelton has been a lifeline to McMackin. She feels comfortable calling Shelton about her medications, daily living and progress.
As a patient returns home to their community, some require specialized care. A heart failure specialist at Barnes-Jewish Hospital continues to manage their device care. However, a primary care or other referring physician typically manages any other conditions a patient may have.
Coordination with a patient''s physician is where Shelton, and Beth Kehoe-Huck, RN, another LVAD nurse coordinator at Barnes-Jewish Hospital, step in again. Knowing the health history of the device patients, they can be in contact with the referring physician to answer questions about continuing care, the medications they are on and treatment of the device. If a patient needs to be hospitalized and are in another hospital''s emergency room, Shelton and Kehoe-Kuck will facilitate the transfer of the patient to Barnes-Jewish Hospital to ensure that the course of care takes the device into consideration.
"We are very involved with our patients," said Shelton. "We share in the responsibility for the care of the patient with the referring physician."
"It''s amazing to see patients, who are dying of heart failure, function with these devices," added Shelton. "They really come back. They are at home again, cooking, going on trips. They are doing cardiac rehabilitation. Really, they are living again."